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Eating for Energy: Nutrition Tips to Combat Mealtime Fatigue in ALS

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By: Emily Truscott, MS, RD, LD

Amyotrophic lateral sclerosis (ALS) is a disease that affects how muscles and nerves work together. Over time, it makes movement difficult or impossible. People with ALS often experience problems with chewing, swallowing, breathing, and fatigue.1 Although the exact cause of fatigue in ALS is not well understood, poor nutrition and dehydration can worsen fatigue.2,3 On the other hand, fatigue can make it harder for people with ALS to get enough nutrition. People with ALS that have trouble chewing and swallowing might take longer to finish a meal, which can be exhausting. If this exhaustion prevents someone from finishing a meal, they might miss out on important nutrients and lose weight.3 Weight loss is a negative sign in ALS and can lower a person’s quality of life.4 While tiredness is an obstacle many people with ALS must face, there are nutrition strategies that could help fight against mealtime fatigue.3

Energy-saving Tips

Saving energy before and during meals might reduce the burden of mealtime fatigue. For people with ALS, preparing meals can be tiring.1 Family and friends can help by preparing meals ahead of time, which lets the person living with ALS save energy before meals. Ready-to-eat meals could allow for more energy to be spent on eating instead of preparing food. For example, soups can be made in advance and simply reheated, or smoothie ingredients can be pre-portioned into freezer bags that are ready to blend when needed. Changing food form or texture may also make eating easier, which could help save energy. If chewing cut-up food is difficult, softer food might be less demanding. Minced or pureed foods could reduce the time and energy needed for chewing and make swallowing easier. Additionally, changing food moisture by adding sauces or gravies could make eating less challenging. A speech-language pathologist (SLP) can help find the best diet texture for each person.3 Assistive devices might further fight against mealtime fatigue by making self-feeding easier. Examples include easy-grip utensils, plate guards to help scoop food, and adaptive cups to prevent spills. An occupational therapist can suggest the best tools for each person’s needs.1

Energy-boosting Tips

Since good nutrition is important for maintaining energy levels and minimizing weight loss, strategies that increase the amount of nutrients a person with ALS eats in a single bite might also be helpful.3 Nutrient-dense foods provide lots of calories without needing to eat as much. Foods with healthy fats, like avocados, olive oil, and nut butters, can add extra nourishment to routine meals. These foods can be easily included in the diet by drizzling olive oil over vegetables or adding avocado to a smoothie. Some might find it easier to drink their calories. In this case, a store-bought nutrition drink could provide essential nutrients as part of a normal diet. High-calorie homemade smoothies made with fruit, yogurt, milk, or protein powders could also deliver lots of important nutrients in just one drink. Changing the timing and number of meals could give someone with ALS more chances to get the nutrients they need. Instead of three large meals, a better goal might be five to six smaller meals and snacks daily. This schedule increases the likelihood of finishing meals and allows for time to rest between them.

Hydration and Fatigue

People with ALS might also struggle to drink enough water.5 Dehydration can contribute to tiredness, so drinking plenty of water is important. Sipping on fluids, such as water or sports drinks, throughout the day can help maintain hydration.6

Bypassing Mealtime Fatigue

If eating becomes too difficult, a feeding tube may be an option. A feeding tube delivers the water, medications, and nutrients a person needs without them having to spend energy eating a meal. In some cases, people with ALS might continue to eat foods they enjoy even when they have a feeding tube.  A registered dietitian-nutritionist (RDN) can help people living with ALS decide on the best option for their needs.1

Take Away

Although fatigue and other diet-related challenges make eating more difficult for people with ALS, there are ways to make nutrition manageable.3 It is important to work with specialized healthcare providers who can suggest personalized recommendations. Strategies to save energy might include planning ahead, changing food form and texture, or using helpful devices. Diet changes, like including nutrient-dense foods, nutrition shakes, and sipping on fluids, could help maintain energy levels.3,6 These energy-saving and energy-boosting strategies combined could better enable people living with ALS to fight against mealtime fatigue, maintain good nutrition, and minimize weight loss.

References:

  1. Greenwood D. Nutrition management of amyotrophic lateral sclerosis. Nutr Clin Pract. 2013;28: 392-99. doi:10.1177/0884533613476554.
  2. Ramirez C, Pimental Piemonte ME, Callegaro D, Almeida Da Silva HC. Fatigue in amyotrophic lateral sclerosis: Frequency and associated factors. Amyotrophic Lateral Sclerosis. 2008;9(2): 75-80. doi: 10.1080/17482960701642502.
  3. Tabor L, Gaziono J, Watts S, Robison R, Plowman E. Defining swallowing-related quality of life profiles in individuals with amyotrophic lateral sclerosis. Dysphagia. 2016;31: 376-82. doi: 10.1007/s00455-015-9686-2.
  4. Jenkins TM, Hollinger H, McDermott CJ. The evidence for symptomatic treatments in amyotrophic lateral sclerosis. Curr Opin Neurol. 2014;27(5): 524-31. doi: 10.1097/WCO.0000000000000135.
  5. Burgos R, Breton I, Cereda E, et al. ESPEN guideline clinical nutrition in neurology. Clin Nutr. 2018;37(1): 354-96. doi: 10.1016/j.clnu.2017.09.003.
  6. Jequier E, Constant F. Water as an essential nutrient: The physiological basis of hydration. Eur J Clin Nutr. 2010;64:115-23. doi: 10.1038/ejcn.2009.111