High Fat/High Calorie Trial in Amyotrophic Lateral Sclerosis

Weight loss is a common and severe symptom of amyotrophic lateral sclerosis (ALS), caused
both from inadequate calorie intake and an increased metabolic rate. People with ALS are
generally instructed to increase their calorie intake; however, the ideal amount and type of
calories has not been studied. Several studies in an animal model of motor neuron disease
have shown that a high fat/high calorie diet can increase survival by as much as 38%. Mice
on a high fat diet also live longer than mice fed diets consisting of high protein or high
sugar. We are therefore conducting a phase II safety, tolerability, and preliminary efficacy
trial in ALS of high fat versus high calorie versus normal diet. The normal diet will be
calculated based on the number of calories needed to replace each participant's measured
daily calorie requirement.

Inclusion Criteria:

1. Clinical diagnosis of ALS

2. Male or female subjects aged 18 years or older

3. Must already be tolerating tube feedings through either a gastrostomy tube (G-tube or
PEG) or jejunostomy tube (J-tube)

4. Must require non-invasive ventilation (BIPAP) for less than 10 hours/day

5. Women of childbearing potential must have a negative pregnancy test at screening and
be non-lactating.

Exclusion Criteria:

1. History of hepatitis including non-alcoholic steatohepatitis (NASH), cholecystectomy,
prior biliary disease such as gallstones

2. History of diabetes

3. History of prior myocardial infarction or stroke

4. Laboratory values: Screening alanine aminotransferase (ALT) or aspartate
aminotransferase (AST) greater than 2.0 times the upper limit of normal or total
bilirubin greater than 1.5 times the upper limit of normal

5. Allergy to soy, fish, or milk products