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Malnutrition in ALS

Though researchers are yet to find a cure for Amyotrophic Lateral Sclerosis (ALS), significant progress has been made in managing symptoms and helping patients maintain a better quality of life.  Adequate nutrition is an important aspect of symptom management.    

At the University of Vermont, Rup Tandan, M.D. is studying the role of nutrition in ALS.  Tandan’s work demonstrates that caloric intake diminishes as patients progress in the disease.  

Several factors can lead to a decrease in a patient’s caloric intake.  As ALS weakens muscles, changes in hand function may lead to the patient’s inability to feed himself.   Weakened throat and chewing muscles or a weakened tongue can make it difficult to swallow.   Anorexia and depression may also contribute to the patient’s reduction in caloric intake.

Weakened muscles can increase the body’s demand for calories as changes occur in muscle mass and strength.  ALS complications can include respiratory problems, muscle twitches, muscle tightness and cramps--demands on the body that burn more calories. 

Studies suggest that maintaining adequate nutrition can help patients live longer.  Tandan studied survival in patients who came to the clinic and found that those who were better nourished lived up to three times longer than those who were malnourished. 

People who are unable to take in food and fluids are also at obvious risk of dehydration, a very common but frequently overlooked condition in ALS patients.  Lack of hydration can lead to urinary tract infections, pneumonia, difficulty swallowing and/or breathing, constipation, pressure sores, anorexia, fatigue, spasms and confusion. 

 ALS patients particularly susceptible to dehydration include those who have difficulty swallowing, those who are malnourished and those with respiratory dysfunction.  Female patients are susceptible in that they tend to consume less water than males as a result of their smaller body size. 

There are ways to alleviate nutritional deficiency and its resulting complications.  Percutaneous Endoscopic Gastronomy (PEG) is an option that provides fluids and nutrition directly to the stomach.

Researchers have accumulated good evidence that PEG’s ability to ensure adequate nutritional intake can stabilize body weight and even produce weight gain in some cases.  PEG can also provide a route for medication and hydration.  

“The advantages of PEG are substantial in these areas of nutritional rehabilitation.  Malnutrition can be prevented by modifying the diet in terms of texture and ultimately PEG placement in patients,” said Tandan.

The ALS Association gratefully acknowledges Page Jones, Ph.D., for her executive summary of Dr. Rup Tandan’s webinar titled “Nutrition and ALS” presented on April 8, 2011.

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