ALS Nutritional Toolkit 
                For individuals with ALS and their caregivers 
                            
        
                            
                            
                            
                            
                            
                            
                            
                  Prepared for the ALS Society of Quebec 
                 by Christina Manganaro, Dt.P., dietitian-nutritionist 
                            
                            
                            
                            
                            
                            
            
            
            
            
            
            
            
            
            
                                               
                  Introduction  
                   
                  This nutritional toolkit was prepared for the ALS Society of Quebec by Christina Manganaro, 
                  registered dietitian-nutritionist. Christina completed this project as part of a stage specializing 
                  in neurology towards completion of her master’s degree in nutrition. The toolkit was created as 
                  a resource for individuals with ALS as well as their caregivers, family members and friends who 
                  are living in the community. The contents of the toolkit can be found on the following page. The 
                  purpose of the toolkit is to provide tips and recommendations as a guide for those living in the 
                  community; however, they should always follow those provided by their health care team. An 
                  online version will be available on the ALS Society of Quebec website under the resource 
                  section. The French version of the toolkit is also available both online and as a hard copy. 
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                  For reprinting permissions, please contact Christina Manganaro at 
                  christina.manganaro@mail.mcgill.ca
                  Prepared for the ALS Society of Quebec by Christina Manganaro, Dt.P., dietitian-nutritionist                 2015-04 
                 ALS nutritional toolkit contents 
                  
                  
                 Section 1 – Tips for easier swallowing, optimal nutrition & general information 
                     ·   Tips to make every spoonful count 
                     ·   How to puree and modify your foods 
                     ·   How to thicken your liquids 
                     ·   Tips for easier and safer swallowing 
                     ·   Tips for you and your family if you have experienced changes in your swallowing 
                     ·   What to expect when getting your PEG or RIG tube 
                  
                 Section 2 – Modified diets for swallowing difficulties 
                     ·   Pureed texture 
                     ·   Minced texture 
                     ·   Soft texture 
                     ·   Regular texture 
                     ·   Unsafe foods for those with swallowing difficulties 
                  
                 Section 3 – Resources in your community 
                     ·   Useful resources and websites for dysphagia  
                     ·   Pureed foods and thickened beverages in your community: Montreal 
                     ·   Pureed foods in your community: Salaberry-de-Valleyfield and Beauharnois 
                     ·   Pureed foods in your community: Valcourt 
                     ·   Where to find Campbell’s trepuree in your community? 
                     ·   Where to find Epikura in your community? 
                  
                 Section 4 – Recipes 
                     ·   Thickened ice cream 
                     ·   Recipes & cookbooks 
                  
                 Section 5 – Other resources & references 
                  
                  
                  
                  
                  
                 Prepared for the ALS Society of Quebec by Christina Manganaro, Dt.P., dietitian-nutritionist       2015-04 
                  Tips to help make every spoonful count 
                   
                  If swallowing has become more difficult and meal times have become more tiring, making every 
                  spoonful count is important to help maintain a healthy weight and to make sure you get all your 
                  nutritional needs. Here are some tips to help you achieve this. Review these with your dietitian-
                  nutritionist so that they can help you personalize your diet.  
                   
                       √  Eat 6 or more smaller meals or snacks per day 
                       √  Have beverages after from meals  
                       √  Take short breaks during meals 
                       √  Eat the foods you love! 
                       √  Enjoy regular fat, thick and creamy yogurt as a snack 
                                o  Try Greek yogurt for extra protein 
                       √  Add 1-2 scoops of protein powder (Beneprotein ®) to purees or beverages 
                                o  See Beneprotein ® recipes  
                       √  Add 1-2 tablespoons of butter, margarine, mayonnaise, gravy or cream sauce to purees 
                           vegetables or meats 
                       √  Stir 1-2 tablespoons of flaxseed oil or fish oil to smoothies or cooked vegetable purees 
                           for added good fat 
                       √  Add ground nut or seeds to desserts or smoothies 
                       √  Mix plain soft tofu into purees, desserts, soups or smoothies 
                       √  Add 1-2 tablespoons of nut butter into smoothies or desserts 
                                o  See recipe booklet: Smoothies with milk 
                       √  Mix 2-3 tablespoons skim powder, soy powder, cream, or sweetened condensed milk to 
                           milk, milk beverages, mashed potatoes, cream soups and sauces, cereals, pureed fruits, 
                           milk-based desserts, puddings, hot cereals, milk shakes 
                       √  Use whole milk instead of skim milk, 1% or 2% milk 
                       √  Use milk instead of water when making soups, sauces, hot cereals, or hot cocoa 
                       √  Add liquid pasteurized egg to milk shakes or smoothies – do not use raw eggs 
                       √  Blend beans or lentils and add to meat purees 
                       √  Add ripened, mashed avocado to vegetable soups and purees  
                       √  Add a spoonful of fibre supplement to purees or beverages for extra fibre 
                       √  Have ½ to a whole bottle of nutritional supplement between meals  
                    
                    
                    
                    
                    
                    
                  References 
                  Ordre Professionelle des diététiste du Québec (OPDQ). (2015). Régime riche en énergie et en protéines : Suggestions. Manuel de Nutrition 
                          Clinique. Retrieved from http://opdq.org/mnc/regime-riche-en-energie-et-en-proteines/ 
                  Dietitians of Canada. (2014). Eating Guidelines for Increasing Your Energy and Protein Intake. Practice-based Evidence Nutrition (PEN).  
                          Retrieved from http://www.pennutrition.com/viewhandout.aspx?Portal=UbY=&id=JMfsUQE=&PreviewHandout=bA== 
                  Prepared for the ALS Society of Quebec by Christina Manganaro, Dt.P., dietitian-nutritionist                 2015-04