Glorius - I firmly believe that for those who are declining PEG (as my husband), the presence and motivated participation of the caregiver AT EACH AND EVERY MEAL is essential to success at weight maintenance.
We have all been told that fat in the diet is beneficial for ALS patients. But I believe it is most beneficial to use fats that are unsaturated and "safe." My husband lost 30 pounds very quickly after diagnosis. He was depressed and simply not interested in eating.
My first move was to get him to agree to eat 1/4 cup of shelled walnuts EVERY morning with his oatmeal, banana, prune juice and orange juice. Those walnuts turned his weight around quickly. They are full of good fat and calories and anti-oxidants.
He has maintained a level weight for many months. We have been able to accomplish this because he is not bulbar onset and does not choke. He can still enjoy food and look forward to a meal.
For lunch he eats a big bowl of soup(to which I add beans), a half sandwich on whole wheat bread, half an apple sliced and a cup of Activia yogurt. EVERY DAY.
For dinner he has fish (salmon, which is fatty), casseroles, eggs w/low fat sausage, chicken, or pork chops, with an occasional beef meal. Usually there are mashed potatoes with lots of gravy and green vegetables. I cook virtually every dinner with olive oil. EVERY DAY.
At mid-afternoon I give him a can of Ensure Plus or Glucerna. EVERY DAY.
This process has succeeded because of the consistency of the diet and the cooperation of my husband. He has interesting meals and he wants to live as long as possible.
I cannot emphasize how important those walnuts are.
Good luck.
V
Caregiver