Meal Adaptations through the Stages of ALS

Maximizing Nutritional Calories

Skip skinless chicken breast; go for chicken thighs or legs. Brisket is the most calorie-dense cut of beef. Substitute pork shoulder roast for ham or pork loin. Whole milk, not skim. Don’t bother with ‘lite’ or low-fat products.

Add healthy fats: coconut oil, avocados, nut butters. Note: truly natural peanut butter has 2 ingredients – peanuts and salt. Period.

Sugar isn’t a healthy, or efficient, way to add calories. Excessive sugar has been linked to diabetes and heart disease (as if you need more to deal with!), and anyway, a gram of fat has 9 calories vs only 4 in a gram of sugar. And no, fat doesn’t necessarily cause heart disease. Recent research shows that the type of fat makes all the difference.

Avoiding Certain Textures / Consistencies

Crunchy/crumbly, e.g., chips, nuts – You can still get the flavor of chips or crackers by grinding them up and mixing with a little dip. For recipes using ground beef, skip the step of browning it – don’t need crispy bits. For the flavor of bacon without the crunch, use bacon grease.

Sticky, e.g., peanut butter, fresh bread or flour tortillas – mix peanut butter with applesauce or mashed banana. For bread, lightly toast (but not so much that it becomes crumbly).

Flimsy, e.g., lettuce – if you don’t mind wilted lettuce, load on the dressing! Otherwise the easiest way to get your leafy greens is to add fresh or frozen spinach to whatever you can – soups, sauces, casseroles, omelets, even smoothies (usually fruit completely masks the flavor).

Thin liquids, e.g., broth soups, water and other beverages – you have to stay hydrated, so this is very important. Add pureed vegetables or mashed potatoes to soup. Use unflavored gelatin to thicken cold beverages. In smoothies, a banana thickens better than berries, or add peanut butter.

Minimal Chewing

You can almost always use a food chopper or processor to get the desired consistency of whatever your family is having for dinner. Or adapt your favorite recipes to be ready-to-eat: Grind meat and chop ingredients before cooking.

Use small pasta (e.g., orzo) instead of noodles. At some point I found it easiest to have everything the same texture instead of switching between different foods, so I converted to casseroles.

Homemade protein shakes and smoothies are healthier than Boost and Ensure-type products. The highest-calorie powder I have found is Orgain Organic Meal Replacement.

Pureed Meals

A high-speed blender like Vitamix or NutriBullet does the trick. Pasta and stuffing can get sticky (literally—flour + water = paste) unless there is enough fat or other ingredients. Rice and other grains get thicker the longer they sit. When you get to the point where it takes a while to swallow each bite, you might want to reduce seasonings.

Tube Feeding

You can still use pureed meals, protein shakes and smoothies through the tube, just add more liquid as needed.


Mara's Story

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