Category Archives: malnutrition

Metabolic Support and ALS

As children we grew up with our parents and teachers telling us how important eating well was to our health.  Our bodies are delicately balanced between nutrition and energy. When we are ill, our body often requires additional energy or that metabolic relationship may become damaged.  Some diseases or their symptoms can cause or contribute to the metabolic imbalance.  In ALS, as the disease progresses, this imbalance can lead to “malnutrition, common with progression of disease, muscle strength and breathing capacity due to weakening as well as increase the relative risk of death.”[1]

A recent study was released in June 2016 which examined the relationship between nutrition status and the progression of ALS.  The study was “Association between estimated total daily energy expenditure and stage of amyotrophic lateral sclerosis (ALS) in ALS patients” and it wanted to “investigate the relationship between total daily energy expenditure (TDEE) and progression of disease in ALS patients and sex differences in TDEE.”[2]   The highlights of the study were:

●Total daily energy expenditure (TDEE) decreased with progression of ALS.
●Energy intake of ALS patients was not sufficient as compared with TDEE.
●Nutrition support should be started before stage 3 of ALS.

370 ALS patients’ TDEE were evaluated and followed in regard to resting energy expenditure (REE) and physical activity.  The results were that the TDEE decreased as the ALS progressed.  The study suggests:

that TDEE decreases with progression of ALS, and patients consume insufficient energy compared with required intake at all stages, particularly at stage 3, suggesting that nutrition support should be started at least prior to stage 3. Additionally, among the five equations for TDEE, TDEE 2 could be the best for evaluating the nutritional status of ALS patients.[3]

Previous studies and articles have examined the relationship between energy intake (nutrition) and ALS before.  In 2014 the American Journal of Clinical Nutrition released the article “Estimating daily energy expenditure in individuals with amyotrophic lateral sclerosis.”  Patients with amyotrophic lateral sclerosis (ALS) experience progressive limb weakness, muscle atrophy, and dysphagia, making them vulnerable to insufficient energy intake. [4]

As with any chronic illness, nutritional support is critical.  The challenge is that the physical symptoms of ALS make energy intake difficult. Proactive and ongoing nutritional support and metabolic balance is important in the overall progression and well-being of the patient.

The study published online “Hypercaloric enteral nutrition in Amyotrophic Lateral Sclerosis: a randomized double-blind placebo-controlled trial” emphasizes the need for a dietary and/or nutritional intervention to offset the metabolic dysfunction PALS experience.

In summary, we believe that our study results provide preliminary evidence for a novel, simple, low-cost, low-risk treatment for this devastating disease. The results of this study also support growing interest in the use of dietary interventions to treat neurological diseases. Our results also support the concept that ALS is a multi-organ systemic disease, characterized by metabolic dysfunction.3   We believe that given the promising results of this pilot study and lack of treatment options for ALS, nutritional interventions should be studied in larger randomized controlled trials at earlier stages of the disease.[5]

Simplesa® offers the metabolic plan called the Deanna Protocol for PALS.  This protocol has been found by many ALS patients to help quality of life and slow progression of the disease.  Additionally, other nutritional supplements are available to offset the metabolic balance and gain or maintain weight in PALS or others with health concerns where adequate nutritional intake is compromised or inadequate.

[1] http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2014000200157

[2] http://www.nutritionjrnl.com/article/S0899-9007(16)30096-X/fulltext

[3] http://www.nutritionjrnl.com/article/S0899-9007(16)30096-X/fulltext

[4]https://www.researchgate.net/publication/262046313_Estimating_daily_energy_expenditure_in_individuals_with_amyotrophic_lateral_sclerosis

[5] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176708/