Evaluation of GI Tolerance of Milk Protein Versus Plant Protein Based Enteral Nutrition Formulas in People With Amyotrophic Lateral Sclerosis (ALS): A Retrospective Study

Shreya Patel

Abstract

Amyotrophic Lateral Sclerosis (ALS) is a chronic neurodegenerative disorder classified by the progressive loss of motor neurons, leading to muscle atrophy and weakness. Individuals with ALS typically face challenges in maintaining adequate nutrition. Some patients may opt to receive enteral nutrition (EN) via a gastrostomy tube (Gtube), bypassing oral intake and barriers to swallowing. EN intolerance is reported in 27-38% of hospitalized and critically ill patients. There are no reported data on overall EN intolerance in patients with ALS, and the current research on the relationship between the type of EN formula and GI symptoms in this population is limited. Preliminary findings from other studies in different populations suggest that plant- based formulas may offer benefits compared to milk-based formulas while alleviating specific gastrointestinal symptoms (bloating, constipation, diarrhea, or abdominal pain) associated with ALS. This study aims to analyze the tolerance of standard enteral formulas, specifically comparing plant-based and milk-based options, by assessing the incidence of various gastrointestinal symptoms through a comprehensive retrospective chart review on ALS patients meeting the inclusion criteria. Patients eligible for the study must be diagnosed with ALS, receive a plant or milk-based EN formula via Gtube, and have a follow-up appointment within six months of EN initiation. After institutional IRB approval is received following a standard protocol, data will be collected in 7 participating ALS clinics across the United States using REDCap. The outcomes aim to contribute valuable insights into selecting EN formulas for ALS patients to potentially mitigate gastrointestinal symptoms and improve quality of life.