Management of ALS

Weight loss, complaints of dysphagia, and signs of tongue atrophy and bulbar weakness are familiar to neurologists caring for patients with advanced ALS. Under these circumstances, most physicians seek to support the patient with some type of nutritional intervention. Frequently, the expertise of a nutritionist is sought to advise patients on proper swallowing techniques, to devise diets with more manageable consistency, and to counsel patients and family regarding the proper amounts of protein and calories for optimal nutrition. Ultimately, most patients are considered candidates for enteral nutrition delivered via percutaneous endoscopically placed gastrostomy (PEG).

The nutritional needs of the ALS patient appear to be managed on an ad hoc common sense basis. In the experience of many neurologists, patients do not admit to eating difficulties unless questioned directly. Patients are not deceitful. They focus on their apparent success in consuming a meal, without consciously realizing that they have insidiously modified their eating patterns to accommodate advancing bulbar weakness. They become adept at avoiding choking by eating slowly and carefully. Because these strategies are generally effective in preventing choking, patients do not spontaneously admit to eating difficulties. However, the picture is different when talking to family. In general, they are concerned that the ALS patient is not eating enough of the right type of food and is losing weight.

It is surprising that the scientific study of the nutritional needs in ALS has received little attention to date. This workshop reviewed the current data regarding nutrition in ALS and identified issues requiring further investigation.

The nutritional status of ALS patients.

Slowie et al. ^[1] were the first to investigate the consumption of calories and protein in ALS. They found that 70% of 20 randomly selected ambulatory …