Food and nutrition are a big deal for those with ALS, or amyotrophic lateral sclerosis. As the disease progresses, appetite declines and eating can become increasingly difficult. Though tube feedings are used to maintain nutrition, patients often do not consume enough calories, leading to weight and muscle mass loss. To increase calorie consumption, physicians may recommend calorie-dense foods that contain a lot of sugar and white flour. Unfortunately, such approaches neglect the nutritional requirements of the motor nerves, brain cells, and mitochondria.
I completely agree that nutrition is a critical factor for anyone who has ALS or any other progressive neurological disorder. I am the director of the Therapeutic Lifestyle Clinic at the Iowa City VA Healthcare system. In this clinic, we help people with neurological, psychiatric, and medical problems use diet and lifestyle to address their health problems.
So what about food for those for with ALS? We know that only 5 to 10% of the risk for ALS is due to a genetic mutation. The other 90 to 95% comes from the interaction between a person’s DNA and the environmental factors they encounter during their life. These factors include dietary choices, toxin exposure, physical activity, social networks, family relationships, and infection history. Though no one can change their DNA, we certainly can address the environmental factors that influence our health. It is possible to shift these factors from disease promoting to health promoting. One of the simplest and most powerful ways to reduce the risk of developing chronic disease is making good food choices.
In our clinics, we recommend a modified Paleo diet that has been structured to maximize the intake of 36 nutrients that science has identified as important for healthy brain and nerve function. We ask patients to completely exclude sugar, white flour, and gluten-containing grains because of the potential for unrecognized gluten sensitivity. These foods are replaced with 6 to 9 cups of vegetables – leafy greens, sulfur rich (cabbage family, onion family, and mushrooms), and deeply pigmented vegetables and berries. The diet also includes 6 to 12 ounces of meat, according to size and gender. I prescribe targeted vitamins, omega-3 fatty acids, and vitamin D for most of the people we see in the Therapeutic Lifestyle Clinic. We encourage choosing organic foods, which lessens the body’s toxic load, and recommend the consumer guides from the Environmental Working Group that list the dirty dozen (most pesticide use) and the clean fifteen (least pesticide use) to prioritize which foods to buy organic and what is safe to buy conventionally. This diet contains plenty of vitamins, minerals, antioxidants, essential fats, and resistant starch (formerly called soluble fiber) and provides nerve cells, brain cells, and mitochondria with the nutrients they need. When people embrace this new way of eating, their neurological problems often stabilize and regress.
Food is just as critical for those with ALS, who should also eat this type of maximally nutrient dense diet, in either the form of the modified Paleo diet or our MCT ketogenic diet. We recommend blenderized food over tube feedings (most of which are high fructose corn syrup plus vitamins). Those with ALS should consult a health-care practitioner who has been trained in functional medicine and can provide personalized recommendations.
I have a passion for nutrition because I have suffered from secondary progressive multiple sclerosis since 2003 and spent 4 years dependent upon a tilt-recline wheelchair. I created a dietary and lifestyle program specifically to support better brain health. In just one year on this new program, I went from needing a zero-gravity recliner (because I was too weak to sit up in a regular chair) to being able to bicycle 18 miles with my family. This transformation changed how I viewed disease and health, how I practice medicine, and the focus of my clinical research.
Today, I study the use of the modified Paleo diet, a ketogenic version of the Paleo diet, in the setting of multiple sclerosis. Ketogenic diets have been used to treat seizure disorders since the 1920s; more recently they have been studied as an intervention for brain cancers, Parkinson’s, cognitive decline, and ALS. Most ketogenic diets utilize butter fat, which the liver converts to ketone bodies. The ketone bodies can be used by mitochondria, the power plant in all of our cells, to generate energy. This diet severely reduces protein and carbohydrate intake — the diet is 90% fat (mostly cream, butter, and eggs) and carbohydrates are limited to 25 grams or less a day (the equivalent of 3 cups of lettuce). I have created a medium chain triglyceride (MCT) ketogenic diet that allows for 60 to 80 grams of carbohydrates and still provides the 36 vitamins, minerals, antioxidants, and essential fats needed by the brain and nerve cells to thrive. This diet is an excellent choice for those with ALS, and has helped so many with neurological and cognitive disorders regain their health and vitality.
Thank you for addressing Paleo eating and ALS. I attended a Barnes and Nobel book signing in Minneapolis. I believe my mom is holding her own because we refused to give her the nutritional drinks and diet that were suggested. Thank you for sharing all your knowledge about good food and nutrition!
Keep up the diet! And think about a functional medicine assessment. I give a lot of suggestions in my book – but a visit with a functional medicine doctor may be very helpful. https://www.functionalmedicine.org/
i am the Pollyanna of ALS victims. Ready to try what I believe you suggest. With your diet and my enthusiasm we can’t miss.
Love to all
Please let us know how it goes.
Glad you are ready to use diet and lifestyle to help as much as possible. Do consider a visit to a functional medicine trained doctor too if you can find one. I discuss the concepts in my book and that would also give you a start! https://www.functionalmedicine.org/
Definitely worth a try. Also look into a functional medicine assessment too. https://www.functionalmedicine.org/
What do you suggest for someone who is only able to tube feed at this point?
I know you cured your MS with diet is ALS at all curable through diet and nutrition?
I have been paleo for 4 months now, am taking all the recommended supplements in the Wahl’s book and feel no improvements. My current diagnosis is Sjogrens but one of my doctors is going to test me for ALS. I am getting discouraged because I have seen no improvements. No relief. Just keep getting worse. My holistic doctor isn’t necessarily doing everything she can to help and insurance doesn’t cover any sort of alternative medicine, so needless to say, I am going broke. Any advice? I am about to jump off the paleo band wagon.
Could you have Lyme disease too?
I suspect it is not that uncommon.
i had to modify Dr Wahl’s Protocol a bit to gain results that offered some relief and change – I have Sjoren’s, Rhanald’s, Osteoarthritis and Multiple Sclerosis — I had to completely give up all grains including rice and corn, all dairy, potatoes, night shade veggies, sweeteners of any kind, some fruits, i couldn’t handle Kale for whatever reason my hormones went bonkers and well I had to stop putting it in my plan. Pretty much any and all lectin containing foods that would trigger an inflammatory response. I literally went through food withdrawal which was no different then a drug withdrawal. After 10 days of pain, feel cold, feeling like I had a cold, anxiety, sleeplessness and night sweats I woke up on day 11 and felt renewed! Dr Wahl’s identifies that there are something’s that may need to be adjusted base on our own personal DNA and food sensitivity. I reintroduced rice into my eating and my body was very unhappy! Soy makes me miserable and soy is in almost everything! It’s a process and one thing my doctor told me — we didn’t get sick overnight and it won’t change overnight as we get better. Once I pushed myself to do more physically via physical therapy and self motivated exercise I started gaining more pain relief. I wish you well but don’t give up and honestly I wish I didn’t have a diagnosis except an unknown form of an autoimmune disease and it’s food/dietary needs and movement related. Well wishes!
Excellent work and thanks for sharing!
I have transvers.myelitis with syringomyelia on thoracic medulla.
I bought Terry Wahls book and started to follow it, I can!
Does anyone knows about Syringomyelia, some advice please?
thanks in advance
Diet and lifestyle are your best tools for things under your control.
You may want to investigate fecal transplant which has been helpful for Parkinson’s and MS. The Taymont Clinic in London http://taymount.com/.
can you please tell me where I will get the Wahls modified diet especially aimed at ALS. It is very important I get it as soon as possible for my husband
please contact Dr Wahls.
have done so and will follow this up. Are you on paleo diet or is yours different? Will you be writing a book? Please do!
I do eat butter. I am working on a film and a chapter for the http://www.HealingALS.org book.
Dr. Walls, when I first looked your picture, the first thing that came to mind was, ” I bet when she was a kid, there was a source of pride in the fact that she could spit through her teeth better than (most!) . (a reinterpretation by a 64 year old type 11 diabetic).) (about 51 years ago, I found myself involved and mindlessly influenced by such a crowd that appreciated such a talent and soon thereafter found myself with A smashed face and jaw,,it’s hard even now to believe that perpetrator (but the reality is that it was a 1600 lb. bull)was myself, and it’s taken me this long to understand how and why ! I’m ok now,good health except for the type 2 thing.
Anyway, my sister has MS, can still walk(with cane)- she is about 70 years old, is concerned about her health and at least, to a certain extent, really tries to do something about it. She would probably be interested in the Modified Paleo-and perhaps is ready to follow such a lifestyle, She now lives in Colorado,is the Wife of a retired professor of the School of Mines (Denver).
Thanks Doc. mike pollet(pilgrim)
please contact Dr Wahls. Her bio is on this website.