By Lorraine Danowski, MS, RD
Christopher Pendergast ALS Certified Treatment Center of Excellence, Stony Brook, NY
Adequate nutrition is important for health and wellbeing for all. Those affected by ALS are no different and actually benefit from improved nutrition. During a typical visit to the ALS clinic, the dietitian will assess weight, average length of a meal, fluid intake, approximate calorie and protein intake and will address any specific problems related to the diet. An ALS Association Certified Treatment Center of Excellence ℠ has a multi-disciplinary team of professionals that can assist the individual with ALS. The dietitian, as a team member, works in collaboration with the speech language pathologist who evaluates the appropriate texture of food and thickness of liquids. The dietitian also works with an occupational therapist that can suggest lightweight or built up utensils, energy conservation techniques and non-slip mats to ease self-feeding.
Maintenance of weight is important and those who lose weight between visits are encouraged to eat smaller, more frequent meals and snacks, consume smoothies or other high-calorie shakes and weigh themselves once a week. Simple ways to increase calories are often suggested, such as: adding olive oil, gravy or sauces to meats, or adding a nut butter or other high calorie spread to favorite foods. The use of whole milk can provide more calories to soups, shakes and other recipes. Cookbooks, that include high calorie recipes which are easy to chew and prepare, may be suggested. A list of high-calorie, ready-to-use supplements may also be provided.
Meal length is an important question asked at clinic appointments. This allows the dietitian to recommend changes in the individual’s diet to provide adequate calories and facilitate ease of intake. Suggestions are often made, such as a reduction in the size of pieces of food or the use of softer foods, such as yogurt and scrambled eggs. Substitutions for favorite snacks that are hard to chew or break apart in the mouth easily can be made at this time. The goal is to keep the meal length under thirty minutes to minimize fatigue at meal times and to keep the experience pleasurable.
The importance of hydration is stressed during the clinic visit. Six to eight glasses of liquid should be consumed each day. Water is at the top of the list, but juice, decaffeinated iced tea and milk provide hydration as well. Among other things, adequate hydration thins secretions, helps regulate body temperature and lubricates joints and tissues. Liquids can be thickened to ease swallowing.
A review of a typical day’s intake helps the dietitian see if calories can be added to meet nutritional requirements. Decreased appetite is a common complaint among people living with ALS and consumption of snacks or more frequent, smaller meals may make meeting their needs easier. If weight loss occurs despite these interventions, the dietitian and the rest of the treatment team may discuss and answer questions about a feeding tube to maintain adequate nutrition and hydration.
People with ALS who maintain their weight often live longer lives compared with those who lose weight. Working with the skilled team of professionals at a Certified Treatment Center of Excellence ℠ can help those living with ALS continue to find enjoyment in foods while providing good nutrition, managing symptoms, and preserving the best quality of life.