Module 3: ALS and Dietary Recommendations

Dietary Recommendations for ALS Patients #

Oral Intake #

No “ALS diet” exists, but the following recommendations are suggested:
  1. Small frequent meals and snacks (every two to three hours)
  2. Diet focusing on high calorie and high protein intake
  3. Consideration of oral nutrition supplements
  4. Potential management of constipation (encourage adequate fluid and fibre intake)
  5. Diet texture and liquid consistency changes (modifications usually need to be made as the disease progresses)
Some examples include adding additional calories to meals + snacks and incorporating high calorie, high protein smoothies/milk shakes.

Alternative Feeding: Enteral Nutrition Support #

Enteral Feeding Regimen –  Important Considerations:
  • No specific enteral formula is recommended. Caloric dense formulas are preferred as the time and volume required to meet daily needs is reduced and allows for less time spent administering enteral feeds.
  • As constipation is common among this population, choosing a fibre-containing formula may be beneficial.
  • As malnutrition is common, remember to assess for refeeding syndrome.
  • Most patients can tolerate and prefer bolus or intermittent feeds.
  • Not enough clinical research and data available to support or disprove that a feeding tube could improve quality of life for patients with ALS.
For more information, please visit Alternative Feeding.

Nutritional Requirements #

  • Energy
    • RMR increases as ALS progresses and patients will generally experience an energy deficit
    • Calculating Energy Requirements 
      • If possible measure BEE by undirect calorimetry
      • If indirect calorimetry not available:
        • (1) TEE= HBE + 10% for hypermetabolism + 10% for thermogenesis + 10% for physical activity.
        • (2) 30-35kcal/kg
  • Protein
    • Protein needs are increased due to prevalence of hyper catabolism.
    • Calculating Protein Requirements
      • 1.0-1.5 g/kg

Handouts #

Sources and Further Reading #

  • Clinical Nutrition Handbook, Sunnybrook Health Sciences Centre: pg. 87-99
  • Shoesmith, C., Abrahao, A., Benstead, T., Chum, M., Dupre, N., Izenberg, A., … & Zinman, L. (2020). Canadian best practice recommendations for the management of amyotrophic lateral sclerosis. CMAJ, 192(46), E1453-E1468.

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