Nutrition Diet: What not to eat when you have myasthenia gravis?

According to the National Institute of Neurological Disorders and Stroke, myasthenia gravis (MG) affects approximately 150 to 200 out of every million people. While diet is not a cure, understanding what not to eat when you have myasthenia gravis can be a powerful tool for managing symptoms like muscle weakness and fatigue, and for mitigating medication side effects.

Quick Summary

This guide outlines specific foods and beverages to limit or avoid when managing myasthenia gravis, detailing why these choices can exacerbate symptoms such as difficulty swallowing and fatigue. It also explains dietary adjustments to address common side effects from MG medications, like steroids and anticholinesterase drugs.

Key Points

• Avoid tough, chewy, and hard foods: Meats like steak and dry, crumbly items like crackers can be difficult to chew and swallow, increasing fatigue and posing a choking risk.

• Limit processed, high-sugar, and high-fat foods: These can worsen fatigue, contribute to weight gain, and increase inflammation in the body.

• Restrict salt intake if on steroids: High-sodium foods exacerbate fluid retention, a common side effect of steroid medications.

• Stay away from quinine, alcohol, and be mindful of caffeine: Quinine (in tonic water) and alcohol can worsen MG symptoms, while caffeine may aggravate medication-induced diarrhea.

• Eat smaller, more frequent meals: Smaller meals can help maintain energy levels and reduce the fatigue associated with eating, especially when chewing is a challenge.

Why Diet Matters for Myasthenia Gravis

Myasthenia gravis is an autoimmune neuromuscular disease that causes fatigue and weakness in the voluntary muscles. The muscles responsible for chewing and swallowing (known as dysphagia) are often affected, making eating difficult and sometimes dangerous. For this reason, a key component of dietary management involves modifying food textures to ensure easier consumption. Furthermore, certain foods can exacerbate fatigue or increase inflammation, while others interact negatively with common MG medications.

Foods and Textures to Avoid for Dysphagia

Difficulty chewing and swallowing is a hallmark symptom for many people with MG and requires careful consideration of food texture. Avoiding the following can reduce the risk of choking and make mealtimes less exhausting:

• Hard and tough meats: Steak, hard cuts of beef, or overcooked chicken can be strenuous on the jaw muscles. Opt for tender, minced, or shredded meat instead.
• Dry and crumbly foods: Crackers, cookies, and dry bread can easily fall apart and be aspirated into the lungs. Moistening these foods with broth or gravy can help.
• Chewy and sticky foods: Bagels, tough bread, and some candies require a lot of muscle effort to chew and can pose a choking hazard.
• Foods with tough skin or shells: Unpeeled fruits (like apples and pears), corn on the cob, and certain peas can be challenging to manage.
• Thin liquids: For some, thin fluids like water or juice move too quickly and increase the risk of aspiration. Thickening these liquids can make them safer to swallow.

Foods that Can Worsen Fatigue and Inflammation

Managing energy levels and systemic inflammation is vital in controlling MG symptoms. Some foods can contribute to a cycle of energy crashes and inflammation.

• High-sugar foods: Candy, sugary drinks, and processed snacks cause rapid energy spikes followed by crashes, increasing fatigue.
• High-fat and processed foods: Fried foods, fast food, and excessive saturated fats can increase inflammation and lead to weight gain, putting extra strain on weakened muscles.
• Alcohol: This can directly interfere with muscle function and impact the effectiveness of MG medications. It is best avoided or consumed in strict moderation.
• Caffeine: For some, caffeine acts as a stimulant that can negatively affect symptoms, while for others it can aggravate medication side effects like diarrhea. Monitor your body's reaction to caffeine and adjust intake accordingly.

Dietary Considerations for Medication Side Effects

MG is often managed with medications like corticosteroids and anticholinesterase inhibitors, which can cause side effects that require specific dietary adjustments.

• High-sodium foods: Steroids like prednisone can cause fluid retention. Avoiding excessive salt from canned soups, processed meats, and salty snacks is crucial to manage this side effect.
• Spicy, fatty, or high-fiber foods: Anticholinesterase drugs (e.g., Mestinon) can cause diarrhea. Avoiding foods that irritate the gastrointestinal tract can help. This includes very spicy, fatty, greasy foods, and foods with insoluble fiber like popcorn or bran.
• Dairy products: For individuals experiencing diarrhea from medication, some dairy products can be aggravating. Plain yogurt with active cultures, however, may soothe digestive issues and provides calcium.

Foods and Ingredients to Specifically Avoid

Several specific items have been noted to potentially aggravate MG or interact with medications:

• Quinine: Found in tonic water, quinine can worsen myasthenia gravis symptoms and should be avoided.
• Lemons: Some reports suggest lemons may aggravate MG, though individual reactions can vary.
• Magnesium supplements: Certain MG medications can be less effective if magnesium supplements are taken. Always consult a doctor before taking any supplements.

Comparison of Difficult vs. Softer Foods for MG Patients

To illustrate easier substitutions, the following table compares common foods with more manageable options that require less muscle exertion.

Foods to Avoid	Recommended Softer Alternatives
Tough steak or pork chops	Minced or shredded chicken, baked or poached fish
Crunchy crackers, dry toast	Soft bread soaked in soup, oatmeal, scrambled eggs
Raw, hard vegetables	Cooked, mashed vegetables like potatoes or carrots
Thick-crust bread, bagels	Moistened sandwiches, soft tortillas
Thin liquids (water, juice)	Thickened liquids, smoothies, pureed soups
Salty snacks (chips, pretzels)	Unsalted nuts (if tolerated), fresh fruit, plain yogurt
Spicy dishes (curries, hot sauce)	Mildly seasoned foods, baked chicken with herbs

Mealtime Strategies for Successful Nutrition

Beyond avoiding certain foods, implementing smart mealtime strategies can significantly improve nutrient intake and reduce symptom exacerbation. Instead of three large meals, many with MG find it more manageable to eat smaller, more frequent meals throughout the day. Eating your largest meal when your energy is at its peak is another effective tactic. It is also essential to eat slowly, rest between bites, and sit upright while eating to reduce the risk of aspiration. Consulting a speech-language pathologist or registered dietitian is highly recommended for creating a personalized plan.

Conclusion

Navigating a diet with myasthenia gravis involves understanding your personal triggers and making careful choices about food texture and composition. By avoiding tough, dry, and chewy foods, limiting processed and sugary items, and addressing medication side effects with specific dietary modifications, you can better manage your symptoms and improve your overall well-being. Always work with your healthcare team to develop a nutritional plan that is both safe and effective for your individual needs. For more comprehensive information and support, consider visiting the Myasthenia Gravis Foundation of America.

This information is for educational purposes only and is not a substitute for professional medical advice.

Frequently Asked Questions

Why are tough meats and raw vegetables difficult for people with myasthenia gravis to eat?

The muscle weakness associated with myasthenia gravis often affects the jaw muscles. Chewing tough meats or hard, raw vegetables requires significant muscle effort, which can cause rapid fatigue and make eating difficult or even dangerous.

Can high-sugar foods trigger a myasthenia gravis flare-up?

High-sugar foods can cause rapid spikes and crashes in blood sugar and energy levels. While they don't directly cause a flare-up, the resulting fatigue can exacerbate existing MG symptoms and make muscle weakness more pronounced.

How does alcohol affect myasthenia gravis?

Alcohol can interfere with muscle function and may negatively interact with some MG medications. For this reason, many healthcare providers advise limiting or completely avoiding alcohol to prevent worsening symptoms.

Should someone with MG avoid dairy products?

This depends on the individual. Some people find that certain dairy products like milk can thicken saliva, making swallowing more difficult. If a medication is causing diarrhea, dairy may also aggravate it, though yogurt with active cultures is often well-tolerated.

Why is it recommended to reduce salt intake when taking prednisone?

Prednisone and other corticosteroids can cause the body to retain salt and water, leading to fluid retention. Reducing salt intake helps manage this side effect and prevent related complications like high blood pressure.

Is there a specific 'myasthenia gravis diet'?

No specific diet has been definitively proven to cure or prevent MG. However, managing symptoms and medication side effects can be achieved through a balanced, anti-inflammatory diet that includes easy-to-chew foods, managed salt and sugar intake, and specific texture modifications.

Why are small, frequent meals better for people with MG?

Eating smaller meals more often helps maintain consistent energy levels throughout the day and prevents the fatigue that can result from consuming large meals. This strategy is particularly helpful when muscle weakness makes eating a larger amount at once challenging.