Myasthenia Gravis (MG) is a chronic autoimmune disease that causes muscle weakness and fatigue. It happens when the immune system mistakenly attacks the communication between nerves and muscles. In a healthy body, nerves send signals to muscles using a chemical called acetylcholine. In MG, antibodies interfere with these signals by attacking the acetylcholine receptors or other related proteins, preventing muscles from contracting properly.

The muscle weakness caused by MG can affect various parts of the body and can range from mild to severe. Commonly affected areas include:

• Eyes and Eyelids: Drooping eyelids and double vision are often early signs.
• Face and Throat: Problems with speaking, chewing, swallowing, and facial expressions.
• Limbs and Neck: Weakness in arms, legs, and neck, making it difficult to lift objects, walk, or hold up the head.
• Respiratory Muscles: Severe cases can affect breathing, leading to a myasthenic crisis.

Allopathic Interventions

From an allopathic or mainstream medicine point of view, the management of MG involves multiple strategies that aim to address the autoimmune aspect of the disease. These might include:

Immunosuppressive Medications: These drugs reduce the overall immune response, thereby decreasing the production of antibodies that attack the neuromuscular junction. Common immunosuppressants include corticosteroids (like prednisone) and other agents such as azathioprine, mycophenolate mofetil, and cyclosporine.

Plasmapheresis and Intravenous Immunoglobulin (IVIg): These therapies remove or neutralize the circulating antibodies in the bloodstream. Plasmapheresis involves filtering the blood to remove antibodies, while IVIg provides a hefty dose of immunoglobulins that modulate the immune response. Both methods can provide temporary relief, particularly during severe exacerbations.

Monoclonal Antibodies: Newer treatments involve monoclonal antibodies that specifically target components of the immune system. Rituximab, which depletes B-cells (the cells responsible for antibody production), and eculizumab, which inhibits the complement system (part of the immune response involved in inflammation and cell destruction), have shown effectiveness in treating MG.

Thymectomy: The thymus gland is involved in developing the immune system, and in many MG patients, it is abnormal. Surgical removal of the thymus (thymectomy) can lead to improvement or even remission in some patients, especially those with thymoma (a tumor of the thymus) or generalized MG.

Symptomatic Treatment: While not directly addressing the autoimmunity, medications like pyridostigmine help improve muscle strength by enhancing communication at the neuromuscular junction.

The long-term outlook for MG varies widely among individuals. Thankfully, with proper treatment, many people with MG can lead relatively normal lives. And while there is currently no cure for MG, many patients experience periods of remission where symptoms improve significantly. However, it’s essential to understand that MG is a lifelong condition; some may face ongoing challenges with muscle weakness and fatigue. The exact cause of MG is not fully understood, but genetic and environmental factors likely play a role. And that might be the good news.

Health Science to the Rescue?

By understanding the nature of Myasthenia Gravis and adopting appropriate treatments and lifestyle adjustments, individuals with MG can improve their quality of life and manage their symptoms more effectively. This is to say that living with MG requires a comprehensive management plan that not only includes medical treatments but also lifestyle modifications to support overall health.

Hence, a balanced and nutrient-rich diet can be particularly beneficial for individuals with MG. This is because the right foods can help manage inflammation, support muscle function, and enhance immune health, which are all critical in managing MG. So, let’s talk about that.

First, we must realize that Myasthenia Gravis is an effect – not a cause. Second, recognizing that myasthenia gravis is an autoimmune disease helps us narrow down beneficial approaches. This is to say that addressing the autoimmunity of myasthenia gravis is indeed a fundamental approach to managing the disease. Third, it’s important to note that we do not want to “boost” or “suppress” the immune system. Instead, we want to “calm” and “balance” it.

An oversimplification might be to say that diet and physical activity play crucial roles in modulating the immune system and managing autoimmunity. These are the environmental elements that we can control. Hence, we need to understand that a balanced diet rich in nutrients and antioxidants supports immune function and reduces inflammation, while regular physical activity helps regulate immune responses and promote overall health.

Conversely, poor dietary choices and sedentary behavior can exacerbate inflammation and contribute to autoimmune disease development and progression. Therefore, we must act accordingly. However, I would argue that our underlying assumptions about these are flawed. Hence, our overall outcomes are typically less than ideal.

Nonetheless, considering dietary interventions and nutritional support as part of the management of Myasthenia Gravis is very important. Unfortunately, specific nutritional recommendations and supplements are not standard treatments for MG, and many of the recommendations that I have seen would only exacerbate the problem. However, we know that optimizing overall nutrition can potentially calm the immune system, which can benefit patients with autoimmune diseases. Again, we are appealing to “cause and effect.”

Nutrients In Focus

Deficiency in vitamin D has been linked to numerous autoimmune diseases. Sourced from fatty fish, fortified dairy products, and adequate sun exposure, vitamin D (and K2) is crucial, as it significantly modulates the immune system and reduces the risk of autoimmune flare-ups. Many people, especially those with limited sun exposure, are deficient in vitamin D, making supplementation essential in many instances.

Magnesium is another essential mineral. Present in meat, fish, and certain fruits like bananas and avocados, magnesium is one of those minerals that is vastly underappreciated in this fight. Not only is it vital for muscle function and helps to reduce muscle cramps and fatigue, but it also happens to be one of the most significant micronutrients in biological systems, specifically due to its immune-regulating actions and its crucial role in regulating inflammation.

Iodine is another big one. Many people are deficient, but it’s essential for thyroid function. Unfortunately, there is a strong link between thyroid health and autoimmune diseases. In fact, thyroid dysfunction can exacerbate MG symptoms. Ensuring adequate iodine intake could help maintain thyroid health. Consuming iodine-rich foods, such as seafood (from the ocean) such as cod, tuna, shrimp, and haddock, or eggs, especially those from chickens fed iodine-rich diets or raised in areas with iodine-rich soil, can go a long way. Similarly, strawberries are one of the few fruits that naturally contain iodine, although the levels can vary depending on soil composition and farming practices.

Vitamin B12 is essential for neuromuscular health, and it’s vital to ensure adequate intake, especially for patients with Myasthenia Gravis. While red meat is a rich source of vitamin B12, it’s important to balance its consumption with considerations about inflammation. Red meat can be included in the diet in moderation, focusing on lean cuts and grass-fed options, which have a better fatty acid profile. Besides red meat, other good sources of vitamin B12 include poultry, fish, eggs, and dairy products. B12 supplements can also be considered, particularly for those with dietary restrictions or absorption issues.

Other essential nutrients include calcium, zinc, and Omega-3 Fatty Acids, which can all be obtained by consuming a diet rich in meat, seafood, and dairy products. Iron is also important and abundant in red meat, poultry, and fish. However, it is important to note that pairing iron-rich foods with vitamin C-rich fruits can enhance absorption.

Speaking of absorption, we cannot forget our gut health. Gut health is crucial for immune function. Thankfully, the diet discussed here will improve gut health. However, sometimes a little extra help is necessary. For this, remember that probiotics from fermented foods like yogurt and kefir can support a healthy gut microbiome.

The Powerhouse of Sulfur

Sulfur gets its own heading because it’s one of those minerals often overlooked in this fight but absolutely necessary. In fact, sulfur plays several crucial roles in maintaining overall health, particularly for individuals with autoimmune conditions. For example, it is a crucial component of amino acids (like methionine and cysteine) and vitamins (like biotin and thiamine).

More importantly, sulfur is integral to the production of glutathione, a powerful antioxidant that helps protect cells from oxidative stress. In fact, it is often called our “master molecule.” Reducing oxidative stress is important for MG patients as it can help mitigate inflammation and support immune function. Of course, there are several other benefits to mention in this fight, which include:

Joint and Muscle Health: Sulfur is essential for the formation of connective tissues. It helps maintain the integrity and function of joints, cartilage, and muscles. This can be particularly beneficial for MG patients experiencing muscle weakness and fatigue.

Detoxification: Sulfur plays a role in the body’s detoxification processes, particularly in the liver. Efficient detoxification helps reduce the burden of toxins that can potentially trigger or exacerbate autoimmune responses.

Anti-inflammatory Properties: Sulfur-containing compounds like MSM (methylsulfonylmethane) have anti-inflammatory effects. These can help reduce chronic inflammation, a common issue in autoimmune conditions.

The REAL Anti-Inflammatory Diet

So, that’s a pretty long list. Don’t worry, it’s actually very simple to get what we need. However, I will start this section with a bit of a warning. While some MG patients may benefit from certain foods rich in essential nutrients, others may need to avoid specific dietary triggers that exacerbate symptoms. Clearly, allergies and known triggers should be avoided, and this includes any foods, supplements, or activities that are known to make your specific condition worse.

That said, knowing that we need the nutrients is one thing. Understanding our best bioavailable sources (that don’t cause inflammation or negative immune responses) is another. And while dietary interventions alone may not replace conventional myasthenia gravis treatments, they can definitely complement medical management and contribute to better overall health and potentially improved outcomes in managing the disease.

To calm the immune system, we must balance inflammation, ensuring it serves its protective role while mitigating its potentially harmful effects. Unfortunately, chronic inflammation disrupts regulatory mechanisms of the immune system, leading to immune dysfunction characterized by impaired immune cell function, autoimmune reactions, and tissue damage. Hence, managing inflammation is essential for restoring immune balance and preventing the progression of immune-related disorders.

Here, it’s important to understand that if you ingest something your body recognizes as a problem, it will respond accordingly. If the body is already dealing with a problem, such consumption can feed the storm that your body is trying to manage. Hence, we want to ensure that what we consume is either reducing inflammatory processes or simply not contributing to them. This approach is sometimes referred to as an “Anti-Inflammatory diet.”

However, when you look up “Anti-inflammatory diet,” you will see a variety of recommendations. Curiously and almost universally, there are recommendations that include inflammatory foods or foods that would elicit a strong immune response. That’s typically not very helpful! So, we need a “real” anti-inflammatory approach – a diet that can help manage autoimmune conditions by actually reducing overall inflammation. But this requires a bit of a different perspective.

Key Components of the Diet

Indeed, the best way to get our nutrients is through a solid diet. However, there seems to be a lot of confusion about what that looks like. In truth, the best sources of the nutrients we have discussed come down to two food groups: animal products and fruit. However, I am also going to suggest that we should avoid anything not on the list. I will explain this thought under “Foods to Avoid.”

Lean meats are excellent sources of high-quality protein, essential vitamins, and minerals, including vitamin B12, sulfur, iron, and zinc. These nutrients, specifically, are critical for neuromuscular health and overall immune function. Of course, protein-rich foods such as eggs, meat, fish, and poultry are also excellent sources of sulfur-containing amino acids. Chicken, turkey, lean cuts of beef and pork, fish, and seafood are excellent sources of vitamin B12. Moreover, these meats provide essential amino acids for muscle repair and maintenance, which is particularly important for myasthenia gravis patients experiencing muscle weakness.

Fruits are rich in vitamins, minerals, antioxidants, and fiber, contributing to overall health and reducing inflammation. However, for this, we need to focus on things like berries (blueberries, strawberries, raspberries), citrus fruits (oranges, grapefruits), apples, bananas, pears, and melons. Doing so ensures that we are getting what we need.

Typically, such a diet is split up using the 80/20 Rule. Roughly 80% of any plate should be animal products, and 20% should be fruit. This includes the fruits often misclassified as vegetables. Furthermore, the animal products and fruits should vary from week to week. This is to say that mixing it up from time to time is a good thing. This type of diet can help ensure that vital nutrients are consumed while minimizing potential inflammatory responses.

Foods to Avoid

Ideally, we should be avoiding immune system irritants. Some are worse than others, but the way I see it is that a little bit of poison is still poison. This is to say that certain foods can exacerbate inflammation and should be limited or avoided entirely. From a physiological standpoint, this means avoiding foods we are not designed to consume, foods that hinder nutrient uptake, or foods that illicit a negative physiological response upon consumption.

For example, antinutrients such as phytates, oxalates, and lectins are immune system irritants that can interfere with nutrient absorption and are known to contribute to low-grade inflammation. It only seems logical that we would either reduce or eliminate them. Of course, refined sugar is also a problem. In fact, let’s just examine a short list of irritants that we might want to avoid:

• Processed foods – all, but especially those high in refined sugars, unhealthy fats, and additives.
• Grains and refined grains – all, but especially wheat and oats.
• Vegetables in general, but especially spinach, kale, broccoli, Brussels sprouts, cabbage, and cauliflower.
• Legumes and nuts, which also include beans, soybeans, lentils, and peanuts.
• Sugary beverages, such as sodas, juices, and other drinks that are high in added sugars.
• Etc.

If you would like to learn more about this diet, be sure to read Nature’s Intent: A Nutritional Philosophy

Practical Implementation

Here is a sample of what this might look like on a given day:

• Breakfast: Greek yogurt with mixed berries.
• Lunch: Grilled chicken salad with a variety of fresh fruits.
• Dinner: Baked salmon with a bowl of fruit.
• Snacks: Fresh fruits and seeds in moderation.

Digestive Reset

Another point to consider is that eating three meals a day may not be necessary for everyone. Allowing extended periods between meals or incorporating intermittent fasting can give your intestines time to heal and restore their natural balance. This approach not only supports digestive health but can also enhance overall immunity. By reducing the frequency of meals, you provide your body with a break from constant digestion, which may improve nutrient absorption and reduce inflammation. Additionally, intermittent fasting can help regulate blood sugar levels, support metabolic health, and potentially aid in weight management. As with any dietary change, it’s important to listen to your body and consult with a healthcare professional to tailor the approach to your individual needs.

If you decide to explore this approach, consider implementing an “eating window” strategy, where you limit your food intake to a specific period each day. For instance, you might choose an 8-hour window, such as from 10 a.m. to 6 p.m., during which you consume all your meals and snacks. Or, you might choose a 4-hour window, such as from 3 p.m. to 7 p.m.

Outside of whatever window you choose, you would fast, allowing your digestive system to rest and recover. If you want to skip meals or snacks to extend the fasting period, do so strategically by focusing on your body’s signals and choosing times that align with your natural hunger patterns. This method helps maximize the benefits of fasting while ensuring you still meet your nutritional needs during your eating window.

Dropdown to Learn More: Why This Tactic Might Work

For someone suffering from Myasthenia Gravis, using an “eating window” strategy might be beneficial for several reasons.

Potential impact on the gut-brain axis: This axis is a complex communication network between the gut and the brain, with the gut containing nearly as many neurons as the brain itself. We know that by extending fasting periods, we allow the gut to rest, which can improve gut health and might contribute to more stable energy levels and a reduced burden on the body, potentially alleviating some of the stress associated with frequent meal digestion.

Reduced Inflammation: Intermittent fasting has been shown to reduce systemic inflammation, which could potentially benefit individuals with autoimmune conditions like Myasthenia Gravis, where inflammation plays a role in symptom exacerbation.

Improved Autoimmune Regulation: Some research suggests that fasting can help modulate the immune system, potentially reducing autoimmune flare-ups and improving overall immune function.

Enhanced Cellular Repair: Fasting periods can stimulate autophagy, a process that helps remove damaged cells and regenerate new ones. This cellular repair mechanism may support overall muscle health and function, which is crucial for managing muscle weakness in Myasthenia Gravis.

Metabolic Benefits: Intermittent fasting can improve metabolic health, including better regulation of blood sugar and insulin sensitivity. This may help manage fatigue and energy levels, which can be challenging for individuals with Myasthenia Gravis.

Mental Clarity: Fasting might also support cognitive function and mental clarity by stabilizing blood sugar levels and reducing oxidative stress, which can be beneficial for overall brain function and symptom management.

As always, it’s essential to consult with a healthcare provider to ensure that this approach aligns with the individual’s overall treatment plan.

Cooking and Prep

Next, we should talk about our approach to cooking. Indeed, there are plenty of opinions regarding cooking methods. However, we should generally opt for baking, grilling, steaming, or poaching to preserve nutrient content. We want to get the most out of everything we consume.

On a personal note, I tend to advocate that any cooking oils used should be animal or fruit-based (Olive, Coconut, Tallow, Avacado, Lard, etc.) because these are known to have some great benefits. However, in keeping in alignment with the diet, I would also argue that we should strive to avoid vegetable oils. The rule is simple: if the oil comes from an animal or fruit, you’re good to go. If the oil comes from any other source, you should probably avoid it.

Now, there are plenty of examples and hints to support this, but there are always going to be those who want to debate the idea. However, the existence of ongoing debate merely demonstrates lingering questions and doubts. We don’t want to mess with that. When dealing with chronic disease, we need to be as accurate as possible, as consistently as possible. Why take a chance? Therefore, I advocate for adhering strictly to the animal or fruit-based oils that we know, aligning closely with dietary recommendations, and preventing inadvertent setbacks.

And finally, don’t forget to drink plenty of clean (non-tap/filtered) water and consider herbal teas that do not contain added sugars or artificial ingredients. Remember, if you can’t read it, don’t eat it! Similarly, regular monitoring is also important, and this includes getting bloodwork regularly. Periodic check-ups with a healthcare provider can ensure that nutrient levels are maintained and any deficiencies are promptly addressed.

By focusing on lean meats and fruits, avoiding known irritants, and ensuring a balanced intake of essential nutrients, patients with MG can support their overall health and potentially improve their condition. This approach aligns well with the need to manage inflammation and support the immune system in a compromised state.

Supplements for MG

Indeed, sometimes, diet alone is not enough. When managing Myasthenia Gravis through diet and lifestyle, incorporating certain supplements can be beneficial in calming inflammation and supporting the immune system. Here are a few supplement options to explore with your healthcare provider.

Omega-3 fatty acids, found in fish oil supplements, are renowned for their anti-inflammatory properties and can help reduce the chronic inflammation associated with autoimmune conditions. With this, you should probably avoid daily intake. Instead, supplement like you might eat fish – two or three times a week.

Probiotics can help maintain a healthy gut microbiome. A good quality probiotic supplement can help balance the gut flora, potentially reducing autoimmune responses. However, remember that such supplementation requires a solid diet to foster the beneficial microbes.

Magnesium is absolutely vital, and supplementation is rarely a bad idea. Unfortunately, most magnesium supplements are worthless. The good news is that both magnesium glycinate and magnesium citrate offer high bioavailability.

Supplements like MSM (sulfur) can be considered for those who might have difficulty getting enough sulfur from their diet. MSM is a popular sulfur supplement known for its bioavailability and effectiveness in reducing inflammation and supporting joint and muscle health.

L-citrulline is often overlooked. While no studies explicitly link L-citrulline supplementation to improvements in Myasthenia Gravis, there are potential mechanisms by which it could offer some massive benefits. For example, vasodilation can improve blood flow to muscles and reduce symptoms of muscle fatigue. L-citrulline also has immunomodulatory effects, which can help regulate immune responses and help reduce inflammation and autoimmune activity.

Of course, where necessary, include any other dietary supplements to fill any identified nutritional gaps, particularly for vitamin D/K2. Together, these supplements can form a robust foundation in the natural management of myasthenia gravis, helping to calm inflammation, support the immune system, and improve overall quality of life. However, and just to reiterate for effect, it is essential to consult your healthcare provider before starting any new supplement regimen to ensure it is appropriate for your individual health needs. Similarly, some supplements can interfere with certain drugs, so you will want to discuss the timing of supplement consumption as well.

Experimental Supplements to Consider

There are a few other substances that we should discuss for this condition. Though not traditionally associated with MG treatment, I feel they might offer you some amazing benefits that warrant consideration and further research. As usual, just be sure to discuss them with your physician.

Palmitoylethanolamide (PEA)

PEA is a naturally occurring fatty acid amide known for its anti-inflammatory and neuroprotective properties. It has gained attention in the medical community for its role in managing chronic pain and inflammation, which are common in various autoimmune conditions. Given that MG involves an autoimmune response that disrupts the communication between nerves and muscles, PEA’s anti-inflammatory effects might provide significant benefits. By reducing inflammation around the neuromuscular junctions, PEA could potentially mitigate some of the immune-mediated damage that characterizes MG.

Moreover, PEA’s neuroprotective properties might help preserve nerve function, offering an additional layer of support to patients struggling with this debilitating condition. While direct clinical evidence for PEA’s use in MG is currently lacking, its general benefits in reducing inflammation and protecting nerve cells make it a compelling candidate for further investigation. [Product Examples]

Phosphatidylserine (PS)

Phosphatidylserine is a phospholipid integral to cell membranes, particularly within brain cells. It plays a crucial role in cell signaling, especially related to apoptosis (programmed cell death). MG can affect cognitive function due to the chronic fatigue and muscle weakness associated with the disorder. PS is known for its ability to support cognitive function, potentially improving mental clarity and reducing fatigue in MG patients.

Additionally, PS helps maintain the integrity and functionality of cell membranes. This could be particularly beneficial for the health of neuromuscular junctions, which are compromised in MG. While there is no direct clinical evidence supporting the use of PS specifically for MG, its benefits for cognitive function and cellular health provide a rationale for considering its inclusion in a broader treatment strategy. [Product Examples]

Choline

Choline is an essential nutrient that plays a pivotal role in maintaining the structure and function of cell membranes, as well as in the synthesis of acetylcholine, a key neurotransmitter involved in muscle control. Choline is naturally found in abundance in things like eggs, liver, and fish, as well as chicken and beef, to a lesser degree. Hence, those with restrictive diets may not be getting enough. However, given that Myasthenia Gravis directly affects the neuromuscular junction, choline’s functions are particularly relevant. [Products Example]

Theoretical Benefits of Choline Supplementation for MG

• Acetylcholine Production:
  • As previously mentioned, MG involves an autoimmune response that disrupts the normal function of acetylcholine receptors, leading to muscle weakness and fatigue. Increasing choline intake could potentially enhance the production of acetylcholine, which might improve neuromuscular transmission and alleviate some of the symptoms of MG.
• Cell Membrane Integrity:
  • Choline contributes to the synthesis of phospholipids, crucial components of cell membranes. By supporting the integrity and functionality of cell membranes, choline may help maintain the health of neuromuscular junctions affected by MG.
• Neurological Support:
  • Choline is also important for brain health and cognitive function. Given that cognitive fatigue is a common issue in MG, choline’s role in supporting neurotransmission and brain function might provide additional benefits.

Considerations & Disclaimers

Traditional treatments for MG often focus on immunosuppression and symptomatic relief, but traditional treatments can also come with significant side effects and don’t always address the underlying issues comprehensively. However, PEA, PS, and Choline (used together or separately) might offer another potential avenue for adjunctive therapy that could complement existing treatments. That said, and while their theoretical benefits are promising, it is important to emphasize that there is a lack of evidence on the topic. I’m merely putting them into this article to put them on your radar – because of their known benefits and potential.

Lifestyle Modifications

Indeed, living with MG can be stressful. However, it’s important to note that chronic stress can negatively impact the immune system as well. The good news is that techniques such as yoga, meditation, and deep breathing exercises can help manage stress. Similarly, moderate physical activity, such as walking or jogging, can help manage stress and improve overall health and well-being. However, such activity should be balanced to avoid overexertion, especially in myasthenia gravis patients.

And finally, it’s important to note that dietary and lifestyle changes should be personalized and undertaken with medical guidance. Each patient with MG may have different triggers and responses to dietary and environmental interventions or exposures. Working with a nutritionally competent healthcare provider, possibly someone who specializes in autoimmune conditions, can help tailor an appropriate plan in alignment with your wishes.

I hope this helps. If you or someone you love is struggling with this condition, don’t lose hope. New information is being discovered all the time. Also, while you may implement some of what we have discussed here today, sometimes it takes a little time to calm the body down. Be patient and keep fighting. The body WANTS to heal. Sometimes, we just have to help it out a little.

---

Dr. Robertson is a health researcher and educator, not a physician. The information provided here is not medical advice, a professional diagnosis, opinion, treatment, or service to you or any other individual. The information provided is for educational and anecdotal purposes only and is not a substitute for medical or professional care. You should not use the information in place of a visit, call consultation, or the advice of your physician or other healthcare providers. Dr. Robertson is not liable or responsible for any advice, course of treatment, diagnosis, or additional information, services, or product you obtain or utilize. IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD IMMEDIATELY CALL 911 OR YOUR PHYSICIAN.

Several product links have been provided in this article for demonstration and example purposes. While I am an Amazon affiliate, the links provided herein are not endorsements or recommendations for the product examples listed. Readers are encouraged to conduct their own research and make decisions that best suit their individual needs.