Nutrition should play an important role in every myasthenic’s care plan. In a recent MGFA webinar, Katherine McWaters, a registered dietitian from Nashville Nutrition Partners, shared practical, evidence-based strategies to help individuals with MG support their health through food. Nutrition can be a powerful tool in your care plan.
Start with the Big Picture: Balanced, Sustainable Eating
Rather than focusing on restrictive diets or “quick fixes,” McWaters emphasized a balanced, sustainable approach to nutrition.
This includes:
- Carbohydrates (grains and starches) for energy
- Protein for muscle repair and maintenance
- Fruits and vegetables (about half the plate) for vitamins, minerals, and fiber
- Healthy fats for inflammation support and satiety
- Fluids to maintain hydration
Equally important is the emotional and social role of food.
“Nutrition is more than just what’s on your plate,” McWaters explained. “We want to promote a positive relationship with food, connection, and even pleasure in eating.”
Understanding Inflammation in MG
Inflammation is often discussed in relation to autoimmune conditions like MG, but McWaters clarified an important nuance:
- Inflammation is not inherently bad – it’s a natural healing response.
- Problems arise when inflammation becomes chronic or dysregulated.
Research suggests inflammation may play a role in both the development and progression of autoimmune conditions. Nutrition can help support the body’s regulation of inflammation, but it is not a cure.
“Food can be a tool in managing inflammation, but it doesn’t replace medical treatment,” she noted.
Key Nutrients
McWaters discussed the types of foods and nutrients that are beneficial to our overall health.
1. Plant foods
Plant foods are rich in compounds that support overall health, including antioxidants and phytonutrients to help protect cells from damage and fiber to support gut health, blood sugar regulation, and immune function
There are thousands of these beneficial compounds – far more than can be replicated through supplements. McWaters recommending “eating the rainbow” and focusing on variety to maximize benefits.
2. Omega-3 Fatty Acids
Omega-3s are found in foods like fatty fish, walnuts, and flaxseeds and help regulate inflammation, support brain and cardiovascular health, and aid in cellular repair
3. Calcium and Vitamin D
These nutrients are especially important for individuals with MG who may be on long-term corticosteroids, which can increase the risk of bone loss. Calcium supports bone structure, while Vitamin D helps the body absorb calcium. For this reason, it’s recommended to have enough Vitamin D in your diet or through limited sun exposure to ensure you can absorb the calcium you need.
Supplements: Use Caution and Consult Your Provider
One of the strongest themes of the webinar was caution around supplements. While some may be helpful, McWaters emphasized that supplements are not regulated like medications, “natural” does not always mean safe, and some supplements can interact with MG or medications
Supplements to Approach Carefully
- Magnesium (especially in high doses) – may worsen muscle weakness and is not recommended
- High-dose vitamin D or zinc – risk of toxicity or immune system effects
- Echinacea – may stimulate the immune system
- Melatonin – potential medication interactions
Potentially Helpful (with Guidance)
- Moderate vitamin D (if deficient)
- Omega-3 supplements (if dietary intake is low)
- A multivitamin to prevent deficiencies
“Always consult your healthcare team before starting any supplement,” McWaters advised.
Managing Eating Challenges in MG
Because MG affects muscle function, eating itself can become difficult. Over 50 muscles are involved in chewing and swallowing, making muscle fatigue a real barrier to adequate nutrition. McWaters offered several tips to make mealtime easier and safer.
One particularly helpful strategy she recommends is to create a list of foods that are easy to prepare, easy to eat, and nutrient dense. Personalize this list based on your MG symptoms, your tastes, and the needs of your family. You will be prepared come mealtime.
Tips for Safer, Easier Eating
- Sit upright and eat slowly
- Take small bites and chew thoroughly
- Modify food textures (soft, moist, or pureed foods)
- Avoid mixed textures (like chunky soups with broth) if swallowing is difficult
Managing Mealtime Fatigue
- Eat your largest meal when energy is highest
- Rest before meals
- Choose smaller, more frequent meals
- Use convenience foods when needed
Easy-to-eat, Healthy Foods
- Smoothies or nutrition shakes
- Yogurt or cottage cheese
- Oatmeal or soft grains
- Eggs, pureed soups, or a thin spread of nut butters (too much nut butter may be hard to swallow)
Addressing Common GI Symptoms
Digestive issues are common in MG, often due to medications side effects. Mestinon (pyridostigmine), a very common MG treatment, causes frequent episodes of diarrhea.
Helpful strategies for avoiding gastric upset or managing diarrhea include:
- Avoiding trigger foods (e.g., greasy foods, caffeine, alcohol)
- Adjusting fiber intake (reducing insoluble fiber during flare-ups)
- Replenishing fluids and electrolytes
- Considering supportive therapies (with provider guidance)
Final Takeaways
McWaters closed with a few key reminders:
- Food is fuel—prioritize consistent nourishment
- Focus on adding nutrients, not restricting foods
- Variety matters, especially with plant-based foods
- Be mindful of medication and supplement interactions
- Most importantly: “Nutrition is just one piece of the puzzle.”
For individuals living with MG, small, practical changes—like eating more consistently, choosing nutrient-dense foods, and planning ahead for fatigue—can make a meaningful difference in daily life.