Myasthenia gravis (MG) is a rare autoimmune disorder where the immune system mistakenly attacks the body's cells, tissues, or organs, leading to inflammation and damage. While nutrition isn't a cure, it plays a crucial role in managing MG symptoms like trouble swallowing and extreme fatigue. By choosing foods that are easy to prepare and safe to eat, individuals with MG can feel their best.
Understanding Myasthenia Gravis and Its Impact on Nutrition
MG is a chronic autoimmune neuromuscular disease affecting the signals between nerves and muscles at the neuromuscular junction. In MG, antibodies block, alter, or destroy the receptors used for muscle contraction, interrupting communication between nerves and muscles and causing skeletal muscles to weaken. Those with MG may experience extreme fatigue that worsens with exertion and improves with rest, as well as muscle weakness of the skeletal muscles that may fluctuate. Impulses from the brain travel down nerves but are blocked by antibodies before reaching the muscle.
MG can affect the muscles that aid in breathing and the bulbar muscles in the face and neck, which can interfere with speaking, swallowing, chewing, smiling, and holding the jaw in place. Difficulties with chewing and swallowing (dysphagia) can interfere with nutrition by creating safety issues and limiting food options.
General Dietary Guidelines
While there is no specific "MG diet," following general healthy eating principles is essential. The Department of Health and Human Services recommends eating a variety of foods, maintaining a healthy weight, choosing a diet low in fat, saturated fat, and cholesterol, choosing a diet with plenty of vegetables, fruits, and grain products, using sugars only in moderation, and using salt only in moderation. If you drink alcoholic beverages, do so in moderation.
Specific Nutritional Needs for MG Patients
In addition to general guidelines, people with MG may have specific nutritional needs due to the condition and its treatments.
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Calorie Intake
Ensure you consume enough calories to maintain a healthy weight and energy levels. If you experience difficulty chewing or swallowing, consider eating smaller, more frequent meals throughout the day to avoid fatigue and ensure adequate calorie intake.
Protein Requirements
Protein is crucial for maintaining muscle mass and strength. Include good sources of lean protein in your diet, such as fish (salmon, tuna, cod), poultry (chicken, turkey), lean meat (beef, pork), eggs, beans, and lentils, and tofu.
Vitamins and Minerals
Certain vitamins and minerals play a vital role in managing MG symptoms and overall health.
- Vitamin D: Improves immune response, reduces fatigue. Food sources include fatty fish, fortified foods, and sunlight exposure.
- Calcium: Supports bone health, especially important with corticosteroid use. Food sources include dairy products, leafy greens, and fortified foods.
- Potassium: Replenishes potassium lost due to medication side effects. Food sources include bananas, potatoes, avocados, and apricots.
- Omega-3 Fatty Acids: Support immune health and reduce inflammation. Food sources include fatty fish (salmon, tuna, mackerel), flaxseed, and walnuts.
- Curcumin: Potent anti-inflammatory and antiviral properties. Food source is turmeric root.
- Zinc: May help lessen the severity of viral infections. Food sources include meat, seafood, beans, nuts, and whole grains.
- Vitamin C: May help lessen the severity of viral infections. Food sources include citrus fruits, berries, tomatoes, and peppers.
Important note about Magnesium: While magnesium is an essential mineral, it can interfere with certain MG medications and may even trigger a myasthenic crisis in some individuals. It’s important to consult with your doctor before starting any magnesium supplement and follow their recommendations for usage.
Fiber
Fiber plays a crucial role in bowel health and regularity, which can be particularly important for MG patients who may experience digestive issues as a side effect of medication. Include plenty of fiber-rich foods in your diet, such as fruits, vegetables, beans, nuts, seeds, and whole grains.
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Foods to Eat With Myasthenia Gravis
Incorporating a variety of whole, natural foods provides the fuel to function at your best. Consider these options:
- Eggs: Eggs are soft, easy to chew and swallow, and very nutritious, filled with protein and other nutrients. They contain every essential vitamin for humans except vitamin C. Eating just two eggs per day can provide up to 30 percent of your daily vitamin needs.
- Yogurt: Yogurt contains active cultures known as probiotics, which can support healthy digestive and immune systems. It is also a good source of calcium and protein. Yogurt in combination with vitamin D3 and magnesium can be an important source of bone-strengthening nutrients, especially since long-term use of steroid medication (a treatment option for myasthenia gravis) can lead to bone loss.
- Avocados: Avocados are soft and moist, making them easier to eat. The creamy texture is perfect for spreading on sandwiches, eating with crackers, or whipping into salad dressings. Avocados are an excellent source of anti-inflammatory monounsaturated fats and provide soluble fiber, which is good for digestion. The potassium content in avocados can help counter some of the sodium in your diet to control fluid retention, particularly if you’re taking steroids.
- Green Smoothies: Green smoothies can help you get a wide range of nutritious produce without chewing or cooking. Simply add fresh or frozen greens (spinach works well) to a blender, along with a variety of fruits to sweeten the deal.
Foods to Avoid With Myasthenia Gravis
No food is officially off-limits unless you have a swallowing issue that requires certain food modifications. However, some foods may cause unpleasant side effects.
- Spicy Foods: Doctors may prescribe anticholinergic drugs like pyridostigmine (Mestinon) for myasthenia gravis, but side effects may include nausea and diarrhea. To avoid making these issues worse, choose foods that don’t further irritate the gastrointestinal tract.
- Regular Milk: Milk is high in lactose, which can cause diarrhea for some people. In addition, thin liquids like milk can be hard to swallow safely. Instead of milk, opt for lower-lactose dairy foods like yogurt and cheese.
- Salty Snacks: Steroid medications cause side effects, including water retention, and eating too much sodium can make these side effects worse. Check the food label to find out if your favorite snacks are high in sodium and swap in fresher snack foods, like fresh fruits, vegetables, plain oatmeal, and unsalted nuts.
- Canned Foods: Canned products often contain too much sodium for a healthy diet. Instead, look for frozen items or canned goods labeled as low-sodium or “no added salt.”
Anti-Inflammatory Diet
As an autoimmune disease, MG involves inflammation in the body. An anti-inflammatory diet may be beneficial in managing MG symptoms. This type of diet emphasizes foods rich in omega-3 fatty acids, colorful fruits and vegetables, and spices like turmeric and ginger, while limiting processed foods, refined sugars, and unhealthy fats.
Eating for Gut Health
Some research suggests that gut dysbiosis may contribute to the development and progression of MG. Consider a prebiotic-rich, high-fiber diet, possibly paired with a probiotic supplementation. Gut-focused dietary interventions may be able to reduce some key symptoms of MG, including muscle weakness and fatigue.
Managing Eating and Swallowing Challenges
If you experience difficulties with chewing and swallowing, here are some tips to make mealtimes easier:
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- Modifying food textures: Opt for soft foods that are easy to chew and swallow, such as mashed or pureed vegetables, cooked cereals, yogurt, and soups. Add sauces, gravies, or yogurt to moisten dry foods and make them easier to swallow. Cut food into bite-sized pieces to reduce the effort required for chewing. Thicken liquids to make them safer to consume.
- Assistive devices: Special utensils, modified cups and straws, and thickening agents can help with gripping and manipulating food and drinking liquids.
- Managing fatigue during mealtimes: Stay hydrated, eat smaller, more frequent meals, eat your largest meal earlier in the day, and rest before meals to conserve energy.
Weight Management
Maintaining a healthy weight is crucial for managing MG. Focus on a balanced diet, increase physical activity as tolerated, and work with a registered dietitian to create a personalized weight management plan.
Detoxification and Immunity
Toxins can inhibit the body's natural immunity, which is essential for managing MG. You can support your body's detoxification processes by engaging in daily exercise, drinking plenty of water, eating sulfur-containing foods (cruciferous vegetables, eggs, and green leafy vegetables), and eating prebiotic foods (onions, garlic, bananas, and asparagus).
Stress Management and Active Recovery
Stress can have a significant impact on your immune system and overall health. Incorporating active recovery techniques into your routine can help manage stress and support your well-being. These techniques include breathing exercises, meditation, journaling, yoga, and guided imagery or visualization.
Practical Advice and Meal Planning Tips
Plan ahead, cook in batches, use convenience foods wisely, keep a food diary, and experiment with recipes to make meal planning easier.
Sample Meal Plans
Here are some sample meal ideas that may be suitable for people with MG:
- Breakfast: Scrambled eggs with avocado and whole-wheat toast (ensure the toast is soft and well-moistened)
- Lunch: Chicken salad sandwich on soft bread with a side of fruit salad
- Dinner: Baked salmon with mashed sweet potatoes and steamed green beans
- Snacks: Yogurt with fruit, smoothies, hummus with whole-grain crackers (ensure the crackers are soft and moist)
Recipes
- Healthy green smoothies: Combine leafy greens like spinach or kale with fruits, yogurt, and healthy fats like avocado for a nutritious and easy-to-swallow meal or snack.
- Hearty black bean burgers: A vegetarian option that can be made with soft, easily-chewed ingredients.
- Tasty and comforting minestrone soup: A soup packed with soft vegetables and beans.
- Flourless chocolate cupcakes: A gluten-free treat that's soft and easy to eat.
- One-pot curry: rogan josh: A flavorful curry that can be made in a slow cooker or pressure cooker, minimizing prep time and effort.
- Roasted sweet potato and ginger soup: A comforting soup with anti-inflammatory ingredients.
Importance of Working With a Healthcare Professional
Every person with MG is unique, and your nutritional needs may vary depending on the severity of your condition, your medications, and other individual factors. It's essential to work with a healthcare professional, such as a doctor or registered dietitian, to develop a personalized nutrition plan that meets your specific needs.
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