To ALS Patients: Put on Some Pounds

Most patients with ALS are encouraged to gradually gain weight.  Yes, you read that right.  It is important to prevent weight loss which could cause further muscle breakdown.  Weight gain is recommended at a gradual pace, about 1-2 pounds gained per month until Body Mass Index (BMI) is in the 25-30 range.  For a six foot tall 40 year old male, that would mean he would want to gain until he reaches about 220 pounds and then try to maintain that weight. 

BMI is calculated by height, weight, and age and can be done easily with an online tool like smartbmicalculator.com.  

For a person with ALS, there are many variables that affect how many calories they need each day.  Muscle fasciculations can burn more calories than another person at rest.  However, over time, decreased physical activity can mean less calories needed.  Difficulty swallowing can also cause patients to not get enough for their needs.

Food needs will change over time.  It is important to re-evaluate how many calories are needed and make sure that those needs can be met.  If a person with ALS is not eating enough calories to meet their needs, the body will begin to breakdown fat and muscle tissues, which is the last thing an ALS patient wants.

Here are some tips and tricks to maximize eating for ALS patients who can still swallow fairly well:

  • Eat small frequent meals
  • Drink some of your calories (juice, smoothies, whole milk, or soymilk)
  • Eat softer foods
  • Nap before meals so you’re not too tired to eat
  • Eat lots of calories during the earlier part of the day if you tend to get too tired to eat later in the day
  • Limit foods that take a lot of energy to chew (steak, salad, celery)
  • Don’t fill up on low-calorie drinks like water, tea, and coffee
  • Eat foods from all food groups, try to keep a good balance
  • Avoid diet versions of foods, choose original full fat foods instead
  • Increase portion sizes 

It is important to realize that it is just as difficult for a thin person to gain weight as a heavy person to lose weight.  It will take work and consistent effort to see a gradual healthy change.  Here are some calorie rich foods recommended for weight gain.  Many of these can be added onto regular foods, for example, add nut butter into your cereal.  Add guacamole or hummus spread into sandwiches.  Eat what sounds good and experiment with adding more of these:

  • Nuts
  • Seeds
  • Peanut butter
  • Dark chocolate
  • Sesame butter
  • Whole wheat crackers
  • Cheese
  • Eggs
  • Fish
  • Meat
  • Raisins
  • Dates
  • Whole wheat bread
  • Dried apricots
  • Coconut milk
  • Avocados
  • Brown rice
  • Oatmeal
  • 100% fruit juices: grape, pineapple, apple, orange

When calorie needs cannot be met any longer with regular food by mouth, it is recommended to use a feeding tube to supplement calories.  This difficult milestone is a topic for another day, but important to maintain weight for a person with ALS.

To view a one hour NEALS Nutritional Intervention webinar from March 4, 2016, go to this link: https://vimeo.com/157773402 presented by 

Edward J. Kasarskis, M.D., Ph.D.

Anne-Marie A Willis, M.D., M.P.H.

Jane L. Hubbard, M.S., R.D., L.D.N

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