NUTRITIONAL SUPPLEMENTS

NUTRITIONAL SUPPLEMENTS FOR MUSCULAR DYSTROPHY

Nutritional requirement in patients with Muscular Dystrophy is often ignored due to lack of research. However it is gaining importance due to the nutritional deficiencies often seen among such patients. Patients with muscular dystrophy may be prone to nutrient deficiency due to mobility limitations or oropharyngeal weakness. Patients with myotonic muscular dystrophy may be particularly prone to such deficiencies from associated dysmotility of the entire gastrointestinal tract. Research demonstrated inadequate nutrient intake of protein, energy, vitamins (water and fat soluble), and minerals (calcium and magnesium). Significant correlations were found between measures of strength and certain individual nutrients (e.g. copper and water-soluble vitamins). Research indicates that a substantial number of adults with muscular dystrophy do not meet current dietary intake recommendations. (1)

Requirement of Energy and Proteins vary from patient to patient depending on the level of physical activity. The recommended dietary allowances for other nutrients also vary. However, foods rich in nutrients like calcium, magnesium, copper, selenium are administered to such patients.

 

1. Energy:

 

The energy requirement in muscular dystrophy cases is 30 % more due to severe muscle wasting. (2)

Okada et al. (3)

found that the basal metabolic rate (BMR) of patients with DMD was higher than that of controls for all ages, with the difference increasing with age, and being about 20% to 30% higher in older boys with DMD. Boys under the age of 14 need to watch the total caloric intake as obesity may set in due to restricted physical activity. However, in older boys undernutrition is observed and researchers have tried to link the BMR and BEE (basal energy expenditure) to the rate at which muscle wasting occurs. Therefore, an approximate calculation for energy is, (4)

Energy = Weight * 25 (+500) kilocalories

 

2. Protein:

 

Proteins are molecules of amino acids which are required by the body for proper functioning of cells, tissues and muscles. Since a large part of the muscles contain protein, the daily requirement of patients with muscular dystrophy is set to be approximately 1.2 gms /kg body weight. The excess protein requirement is to replenish the muscle proteins. Good quality protein with higher biological value is recommended. Egg whites, whole beans and pulses, sprouts, milk and milk products, soy proteins

(if no allergy) must be included in the daily diet.

 

3. Calcium and Magnesium:

 

Calcium and magnesium is critical for the muscular and nervous system and for the production of ATP molecules which provides cellular energy. Whether dystrophin and its associated proteins have a direct role in the regulation of calcium ions, calcium channels or intracellular calcium stores, or indirectly alters calcium regulation through enhancement of membrane tearing, remains unclear. (5)

Calcium is available in many foods. Most people think of dairy when they think of calcium. Though cheese is a good source of calcium it is high in saturated fat. A varied diet should be taken to get the best calcium absorption. It is estimated that only 30% of dietary calcium is absorbed.

 

Factors which inhibit calcium absorption and may contribute to

calcium loss are:

 

Aluminum (foods cooked in aluminum cookware including the use of acidic foods with the cookware), aluminum foil, antacids containing aluminum and high levels of magnesium.

Zinc, oxylates (a chemical that is found in sweet potatoes, dried beans, concentrated forms of phytic acid (such as found in wheat bran and dried beans)and dietary fiber inhibit calcium absorption.

Alcohol, phosphates (in soft drinks and meats), sugar, and protein increase calcium excretion. High levels of sodium may also be linked to calcium excretion. Including foods such as whole grain cereals like ragi, jowar, leafy vegetables, till seeds, flaxseeds, methi (fenugreek seeds), almonds, and walnuts can increase the calcium intake in the daily diet.

The scientists also found that patients had lower-than-normal levels of a form of bioactive vitamin D and adequate dietary calcium intake seems to be an effective first-line approach that controls bone turnover,

corrects vitamin D deficiency. (6)

 

4. Selenium:

 

It is an antioxidant that works closely with vitamin E in actions like production of antibodies. Selenium protects the cell "machinery" that generates energy. It is also necessary for the production of prostaglandins, substances which affect blood pressure and platelet aggregation. Deficiency of selenium has been associated with premature aging, heart attack, muscular dystrophy. (7)

Studies by Ornadhl et al have shown drastic improvements in patients with Myotonic dystrophy with additional dosage of

Selenium and Vitamin E.

However, further studies and trials have to be done to confirm the improvement in such patients.

 

5. Green tea:

 

Over a last few decades green tea is under tremendous research for the amazing health benefits imparted on it.

A research study conducted in Switzerland concluded that the antioxidant mechanism in green tea improved muscle health by delaying muscle necrosis in mice. (8)

Before the identification of the deficient proteins that underlie muscular dystrophies, such as Duchenne muscular dystrophy (DMD), oxidative stress was proposed as a major cause of the disease. (9).

The antioxidants in green tea neutralize these free radicals thereby preventing cell damage. Dorchies et al have conducted studies on mice with green tea extracts preventing muscle necrosis. (10)

 

6. Omega 3 fatty acids:

 

The inclusion of omega 3 fatty acids in the diet is not only said to be effective for patients with cardiomayopathy, but also improves the muscle tissue appearance. Fiaccavento et al carried out a study wherein dystrophic animals were fed flaxseed-derived ω3-α-linolenic fatty acid. They found that histological appearance of the muscular tissue was improved, the proliferation of interstitial cells was decreased, and the myogenic differentiation originated new myocytes to repair the injured muscle. In addition, muscle myofibers were larger and cell membrane integrity was also preserved, as witnessed by the correct

localization of α-, β-, and γ-sarcoglycans and α-dystroglycan. (11)

 

OTHER NUTRITIONAL ISSUES IN PATIENTS WITH MUSCULAR DYSTROPHY

 

Although the causes of gastrointestinal symptoms in patients with MD are multifactorial, small intestinal bacterial overgrowth is an important diagnostic consideration that is easily diagnosed using glucose breath hydrogen testing and often shows a good response to treatment with common antibiotics. (12)

 

Constipation is often an issue with such patients. Dealing with abdominal distention and feeling of fullness is of primary concern. Bringing about dietary changes like including high fiber foods in the diet such as fruits and vegetables along with plenty of fluids. This increases the fecal bulk by absorbing the water in the colon relieving constipation.

 

Childhood obesity is another major concern in such children. Overfeeding along with lack of physical activity further aggravates the weight gain process. (13)

 

Dietary guidelines for muscular dystrophy patients:

 

Small frequent meals throughout the day.

 

A good heavy breakfast comprising of cereals and pulses or protein foods, as it provides energy for the entire day.

 

The afternoon meal must be a balanced one with complex carbohydrates (whole cereals) and a serving of protein food with high biological value.

 

Mid morning and evening snacks which must be low in calorie and fiber rich foods.

 

A very light dinner with soft and easy to digest vegetables to avoid gastrointestinal discomfort.

 

Plenty of fluids (soups, lime juice, buttermilk, coconut water) throughout the day to relieve constipation.

 

Non-vegetarian foods like chicken and fish can be included provided they are cooked in lesser amount of fat.

 

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