National Malnutrition Awareness Week kicks off today. The ALS Association has resources available to help make sure people living with ALS do not struggle with malnutrition as the disease progresses. 

Adequate nutrition can become a critical concern for people living with ALS and their caregivers. Once ALS takes away a person’s ability to swallow safely, placement of a PEG (through the abdomen) feeding tube provides a viable option to maintain adequate nutrition. 

Due to the disease process, individuals with ALS are particularly at risk for malnutrition due to the presence of hypermetabolism (burning calories faster than “normal”) and because they are eating less due to swallowing problems and fatigue. This leads to weight loss and further muscle wasting beyond the breakdown of muscles caused by the disease itself. 

The ALS Association provides numerous resources to inform caregivers and help make sure nutritional needs are met throughout the disease progression. 

To help maintain a healthy and nutritious diet, consider some of these tactics (all described in detail in our downloadable free guide): 

1. Choose foods that are normally soft—Make it easier by starting with foods that require little chewing, such as bread, rice, pudding, hummus, soft boiled eggs, and apple sauce.
    
2. Modify the consistency of food using a blender—Puree foods that are more difficult to chew and swallow into a pleasantly thick liquid by blending with water, milk, almond milk, or soup. Blend a healthy range of meats, fish, fruit, and vegetables.
    
3. “Lubricate” food—Make it easier to swallow dry foods using sauces, gravies, dips, and dressings. This will help the person with ALS to experience less fatigue during mealtimes and conserve energy throughout the day.
    
4. Practice safe swallow strategies—There are four techniques to try including the effortful swallow (swallowing hard), the chin tuck posture (holding your chin to your chest), taking small bites/single sips, and double swallowing (swallow 2x per sip or bite).
    
5. Consume adequate protein—Try including milk, cheese, eggs, legumes, and creamy quinoa in your diet. Or puree protein-rich foods as suggested above. If you do not consume adequate protein in your diet, your body will resort to breaking down energy stores in your muscles and organs.
    
6. Increase calorie intake—Add calories to each meal by drizzling with olive oil or coconut oil. Serve meals with avocado, guacamole, nut butters, whipped potatoes/sweet potatoes, cream sauces, cream-based soups, cheese, or cream cheese. Don’t forget ice cream or yogurt for dessert!
    
7. Supplement meals with shakes or smoothies—Create your own shakes or smoothies using your favorite fruits, vegetables, yogurts, and nut butters. Ask your dietitian about adding protein powders for added nutrients. Or use store-bought products such as Ensure® or Boost®.
    
8. Reduce the length of mealtimes—Try to keep meals short to decrease fatigue. Serve smaller, but more frequent meals and snacks. Supplement as needed.
    
9. Take medications with pudding, applesauce, or yogurt—This will make it easier to swallow the medicine while providing added calories.
    
10. Stay hydrated—With a loss of just 1.5% loss of body water, mental and physical function declines. A dietitian can help determine how much fluid you need. Using special cups (such as Dual Cup™ or Provale™) may increase fluid intake by making it easier to drink.
     
11. Feeding tube—If you are struggling to consume enough food, having trouble maintaining weight, having difficulty staying hydrated, or breathing tests show decreased function, a feeding tube may be necessary. Having a feeding tube does not mean you can no longer eat or drink. It simply provides an additional method of meeting fluid and nutrition goals.

To learn more about how swallowing is affected in ALS and what you can do to maintain nutrition for energy and strength, please download this free guide from The ALS Association.