# Nutrition in Multiple System Atrophy
Esophageal function and swallowing
In MSA, the muscles involved in swallowing can gradually weaken, especially as the disease progresses. This process is called dysphagia. Recent research has shown that the pressure you can exert with your tongue is a reliable indicator of more severe swallowing problems.
ProveniIncluded in official guidelines, or approved by EMA or FDA
This means that nutrition is not only about *what* you eat, but also about its *consistency*. Food that is easier to swallow — such as soft or liquid food — may become necessary as the disease progresses. This is something that can be assessed together with your doctor and speech-language pathologist or dietitian, because timing and individual circumstances are important.
Nutritional status and body composition
Research from 2026 shows that there is a relationship between your body composition and certain heart complaints (orthostatic hypotension, where you become dizzy when standing up) that are common in MSA.
ResearchediPositive results in clinical studies, not yet standard treatment
This suggests that a healthy nutritional status — neither too much nor too little weight — may be important for managing these symptoms. However, research into this is still ongoing, and what 'healthy' is varies greatly per person and disease stage. This is a topic to discuss regularly with your treatment team, especially if your weight changes or you experience dizziness.
Nutritional intake and digestive functions
As MSA progresses, it can become more difficult to take in enough nutrition. This can have various causes:
- Difficulty chewing and swallowing
- Reduced appetite
- Fatigue during eating
- Problems with digestion itself
In those cases, doctors can sometimes insert a feeding tube (percutaneous endoscopic gastrostomy, PEG), which delivers nutrition directly into the stomach, bypassing the swallowing problems. Recent research into this procedure in atypical Parkinsonian syndromes such as MSA shows that patients who receive it have, in certain cases, a lower risk of food aspiration.
ResearchediPositive results in clinical studies, not yet standard treatment
Decisions about this are very personal and depend on your own wishes, underlying health, and where you are in the disease process. Discussing this with your team is essential.
Fat intake and disease progression
Animal experimental research from 2026 shows that a diet high in fat can worsen certain neurodegenerative changes in an MSA model.
ExperimentaliOngoing in study setting, outcome still unknown
This has not yet been directly demonstrated in people with MSA, so it is unclear whether the same applies to you. Still, this may be a signal to look at the composition of your diet together with your dietitian, especially if you consume food high in saturated fat over a long period of time. This is not a reason to panic or make drastic changes, but rather something to consider consciously.
Vitamins and nutrients
MSA is sometimes accompanied by problems where certain vitamins (especially B12) are absorbed less well. This is relevant, for example, if your gastrointestinal function deteriorates.
ResearchediPositive results in clinical studies, not yet standard treatment
Regularly checking whether you are getting enough vitamins and minerals — particularly iron, calcium, B-complex vitamins, and vitamin D — can be important. However, this is something your doctor can check through blood tests, and not something to assess yourself. Supplements may be necessary, but some supplements can also interfere with your medications. It is best to discuss this with your doctor or dietitian.
Hydration status and blood pressure
Because MSA affects the autonomous nervous system, your blood pressure regulation and fluid balance can become disrupted. Some people with MSA experience low blood pressure, others high blood pressure. This can have consequences for how you take nutrition:
- With low blood pressure, regular food with sufficient salt and fluids can sometimes help (under guidance of your doctor)
- With high blood pressure, salt restriction may be necessary
This is something that differs from person to person and what your team will need to determine based on your own measurements and blood pressure.
Practical dietary adjustments
Many people with MSA find that they can digest food better when they:
- Eat more frequently but in smaller amounts instead of three large meals
- Chew meals well or soften food beforehand
- Take sufficient time to eat, without rushing
- Remain upright for a while after eating
These are empirical observations and not established guidelines.
ResearchediPositive results in clinical studies, not yet standard treatment
(based on patient and speech therapist experience reports)
Your dietician can help you create a personalized nutrition plan that matches your ability to chew, swallow, and digest food.
Drug interactions
Some medications prescribed for MSA symptoms can affect your appetite, stomach, and fluid balance. This is a conversation for your doctor — stopping food or supplements on your own because you think they conflict with your medication is not recommended.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._