High-calorie/high fat diet could slow progression of ALS

by Bruce Sylvester: A study published on Feb. 27, 2014 in The Lancet suggests that amyotrophic lateral sclerosis (ALS) patients who are mildly obese are more likely to live longer when they were fed a calorie-rich diet high in fat.

The study was led by  Anne-Marie Wills, MD, a neurologist at the Massachusetts General Hospital, in Boston, Massachusetts. In order to be eligible for the study, patients with advanced ALS had to already have a feeding tube (known as PEG tubes, or percutaneous endoscopic gastrostomy tubes), allowing food to be delivered directly to the stomach.

Twenty subjects were enrolled. They were assigned to three groups, each with a different diets. There was a control group (to maintain weight) and two high-calorie (hypercaloric) groups, one high in carbohydrates, the other high in fat.

Diets lasted for 4 months. Researchers gathered data on safety and survival from the beginning of the study, and at 5 months after it ended.

Subjects on a high-carbohydrate/high-calorie diet had fewer adverse events compared to the control group (23 vs 42), and significantly fewer serious adverse events (0 vs 9) than the control group.

At five months after the end of the dietary intervention, one subject in the high-fat group had died and three subjects in the control group had died. But no one in the high-carbohydrate group had died. Also, subjects in the high-carbohydrate formula group had achieved less of a decrease in functional scores, compared with those in the control group, though the difference was not statistically significant.

Dr Wills said, “There is good epidemiological evidence that, in ALS, survival is determined by nutritional status. This pilot study demonstrates the safety of a novel, simple, low-cost treatment for a devastating disease where currently, very few treatment options are available. The adverse outcomes that we feared might result from weight gain, such as diabetes or heart disease, were not observed in our study period of five months.”*

The authors noted that the findings should be interpreted “with caution”, and called for larger trials testing subjects at an earlier stage in the disease.

“Although the sample size was small, we are optimistic about these results, because they are consistent with previous studies in ALS mouse models that showed that hypercaloric diets improve survival,” said Dr Wills. “Not only could this type of nutritional intervention be a novel way to treat and slow down the progression of ALS, it might also be useful in other neurological diseases,” he added.