What foods are good for ALS patients? Managing nutrition for better health

October 15, 2025 •

4 min read

According to the ALS Association, many patients with Amyotrophic Lateral Sclerosis (ALS) experience hypermetabolism, requiring a higher-calorie diet to prevent weight loss and muscle breakdown. Understanding what foods are good for ALS patients and how to adapt meals is crucial for maintaining energy, managing swallowing difficulties, and supporting overall health as the disease progresses.

Quick Summary

A proper nutrition plan for individuals with ALS focuses on high-calorie, nutrient-dense foods and adapting textures for safe swallowing. The diet should counteract hypermetabolism and manage issues like dysphagia, fatigue, and potential malnutrition, supporting strength and well-being.

Key Points

Prioritize Caloric Density: Due to hypermetabolism, ALS patients need more calories. Focus on adding high-calorie foods like avocado, nut butters, and oils to meals to prevent weight loss and muscle breakdown.
Adapt Food Textures: As swallowing difficulties (dysphagia) progress, modify textures from soft and moist foods to pureed dishes to ensure safe eating and reduce choking risk.
Ensure Adequate Hydration: Dehydration can worsen symptoms. Use thickened liquids if recommended by a speech-language pathologist, or choose high-water content foods like custards and pureed fruits.
Consider Frequent Small Meals: Eating smaller, more frequent meals and snacks throughout the day can help conserve energy and improve overall nutritional intake, especially when fatigue is a factor.
Consult a Multidisciplinary Team: Work with a dietitian and a speech-language pathologist to create and adjust a personalized nutrition and swallowing plan. This team approach is crucial for safety and effectiveness.
Supplement with Caution: Nutritional supplements can boost calorie and protein intake, but always consult a healthcare provider to ensure safety and avoid interference with other medications or treatments.
Focus on Antioxidants and Anti-inflammatories: Some research suggests that foods rich in antioxidants, like brightly colored fruits and vegetables, and omega-3s, such as fatty fish, may have neuroprotective benefits for individuals with ALS.

The Importance of Nutrition in ALS Management

Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that directly impacts a person's ability to eat and swallow over time. Due to increased energy expenditure from muscle twitching and weakness (hypermetabolism), many people with ALS require significantly more calories to maintain their weight and muscle mass. Unintentional weight loss can worsen the prognosis, making nutrition a critical component of disease management.

A well-planned diet, often developed with a registered dietitian, aims to address several key challenges: meeting increased caloric needs with nutrient-dense foods, adapting food textures as swallowing (dysphagia) progresses, and ensuring adequate hydration. By proactively addressing these issues, individuals with ALS can better manage their energy levels and improve their quality of life.

High-Calorie and Nutrient-Dense Foods

To combat hypermetabolism and prevent weight loss, concentrating on high-calorie, nutrient-dense foods is essential. This strategy allows individuals to consume sufficient calories without needing large, tiring portions.

Examples of High-Calorie Foods

Healthy Fats: Add avocado, olive oil, nut butters, or seeds to meals and snacks. Drizzle oils over cooked vegetables or stir nut butter into oatmeal.
Dairy and Dairy Alternatives: Use full-fat Greek yogurt, full-fat milk, milkshakes, or creamy cheeses. For extra calories, add powdered milk to sauces, soups, or puddings.
Protein Sources: Incorporate soft, moist proteins like scrambled eggs, flaky fish (e.g., salmon), and legumes mashed into dips or purees.
Carbohydrates: Use sources like quinoa, sweet potatoes, and oats, which provide sustained energy. Enhance with butter or oil for more calories.

Adapting Food Textures for Swallowing Difficulties

Dysphagia is a common symptom of ALS that can make eating difficult and unsafe. Modifying food textures can significantly reduce the risk of choking or aspiration. A speech-language pathologist can provide an evaluation and recommend the safest textures.

Levels of Texture Modification

Soft and Moist: When chewing becomes a challenge, focus on tender, well-cooked foods. Use sauces, gravies, and dressings to lubricate dryer items. Examples include moist meatloaf, canned fruits, well-cooked pasta, and soft, ripe bananas.
Pureed and Smooth: For more advanced swallowing difficulties, pureeing foods is often necessary. A blender or food processor can create a smooth, consistent texture. Blend meats with broth or gravy, fruits with juice, and vegetables with a stock base.
Thickened Liquids: Thin liquids like water can be particularly dangerous for individuals with dysphagia. Thickening agents can be added to water, juice, or coffee to change the consistency to nectar-, honey-, or pudding-thick, making them safer to swallow. Thicker beverages like milkshakes and nectars are also good options.

Comparison of Food Modifications for ALS Patients


Food Type	Regular (Initial ALS)	Modified (Progressive ALS)
Protein	Lean steak, tough chicken breast	Moist meatloaf, shredded chicken with gravy, scrambled eggs, tuna/egg salad with extra mayo, soft tofu
Carbohydrates	Dry toast, crusty bread, popcorn	Soft bread soaked in liquid, cooked cereals (oatmeal, Cream of Wheat®), soft pasta, mashed potatoes
Fruits	Raw apple with skin, nuts	Canned fruit, applesauce, ripe bananas, pureed fruits
Vegetables	Raw carrots, leafy greens	Mashed carrots, well-cooked squash, pureed vegetable soups, steamed tender vegetables
Liquids	Thin water, broth-based soups	Nectar- or honey-thickened liquids, creamy soups, milkshakes, smoothies

Hydration and Mealtime Strategies

Staying hydrated is crucial, as dehydration can cause thicker saliva and worsen constipation. Keep beverages, whether regular or thickened, easily accessible throughout the day. Eating smaller, more frequent meals can also help conserve energy and prevent fatigue that can make eating challenging. Scheduling meals at times of higher energy and making mealtime a pleasant, relaxed experience can improve intake.

The Role of Supplements and Professional Guidance

Nutritional supplements can help fill gaps in a person’s diet and boost calorie intake. Commercially available products like Ensure® or Boost® can be used, or homemade protein shakes and smoothies can be made with high-calorie ingredients. Always consult with your healthcare team, including a registered dietitian, before adding new supplements. Some studies suggest a higher intake of antioxidants like vitamin E and omega-3 fatty acids may be beneficial, but more research is needed, and supplements can interact with medications.

Conclusion

Nutritional management is a vital part of care for individuals with Amyotrophic Lateral Sclerosis. The primary goals are to maintain body weight by focusing on high-calorie, nutrient-dense foods and to ensure safe eating through texture modification. Working closely with a multidisciplinary care team, including a dietitian and speech-language pathologist, provides the best support for navigating dietary challenges. By prioritizing energy-dense meals, adapting food consistency as needed, and staying hydrated, people with ALS can continue to enjoy food and maintain their nutritional status for improved overall well-being. For additional resources and support, consider visiting the ALS Association website.

ALS Association

Foods to Consider for ALS Patients

High-Calorie Boosters: Incorporate nut butters, avocado, olive oil, and full-fat dairy to increase caloric density without increasing portion size.
Soft Proteins: Prioritize soft, easy-to-chew protein sources like scrambled eggs, flaky fish, and ground meats with gravy.
Easy-to-Swallow Carbs: Rely on mashed potatoes with butter or gravy, cooked cereals, and soft pasta for energy.
Antioxidant-Rich Produce: Include ripe bananas, applesauce, and cooked, pureed vegetables for essential vitamins and minerals.
Smooth Liquids: When swallowing thin liquids is difficult, use thickened drinks, milkshakes, and creamy soups to stay hydrated.

The Role of a Dietitian for ALS Patients

Individualized Plans: A dietitian can assess specific needs, create a personalized nutrition plan, and make ongoing adjustments based on disease progression.
Weight Management: They help monitor weight and create strategies to counteract unintentional weight loss, which is a major concern in ALS.
Texture Modification Guidance: Dietitians work with speech-language pathologists to recommend appropriate food and liquid consistencies.
Supplement Management: They can provide guidance on appropriate nutritional supplements to ensure adequate calorie and nutrient intake.
Caregiver Support: Dietitians can educate caregivers on meal preparation techniques, feeding strategies, and how to create a supportive mealtime environment.

Frequently Asked Questions

People with ALS often need a special diet to address increased caloric needs due to hypermetabolism and to manage swallowing difficulties (dysphagia) that can lead to malnutrition and weight loss.

The easiest foods to swallow are those that are soft, moist, and have a smooth consistency. Examples include scrambled eggs, mashed potatoes with gravy, yogurt, pudding, applesauce, and pureed vegetables.

To increase calorie intake without eating more volume, incorporate healthy fats like avocado and olive oil, use full-fat dairy, and add nut butters. High-calorie nutrition shakes and smaller, more frequent meals can also help.

Dietary supplements can be helpful, but they should only be taken after consulting a healthcare provider. Some supplements may interfere with medications, and a professional can ensure they are safe and appropriate for your specific needs.

It is best to avoid foods that are hard to chew, crumbly, or have mixed consistencies (like thin broth with solid chunks). Examples include dry bread, hard nuts, and uncooked vegetables.

For patients with dysphagia, thin liquids can be thickened using commercial thickening powders or gels. This makes them flow slower and more safely down the throat. Beverages like milkshakes and nectars are naturally thicker.

A feeding tube may be necessary when chewing and swallowing become too difficult, or when a patient is unable to consume enough calories and fluids orally to maintain their weight and nutritional status. Early discussion with a care team is recommended.