Understanding the FA diet: Supporting energy and muscle function

Last updated Nov. 18, 2024, by Lindsey Shapiro, PhD
Fact-checked by Inês Martins, PhD

While there isn’t a specific diet that is recommended for people with Friedreich’s ataxia (FA), a rare inherited neuromuscular disease, certain dietary modifications can help ease some symptoms, such as  fatigue, and help you feel your best when living with FA.

The general recommendation is to adopt a healthy and well-balanced diet as part of a holistic FA care plan, with some guidelines about which foods are likely to have a helpful or harmful effect on FA. This includes eating a lot of plant-derived foods such as fruits and vegetables, limiting sugar and processed foods, and taking certain dietary supplements.

Still, as specific needs will differ based on a variety of factors, decisions about food choices and the use of vitamin or mineral supplements should always be made in consultation with your healthcare team.

The role of diet in managing FA symptoms

FA is characterized by progressive ataxia, or a loss of muscle control and coordination. It is caused by a deficiency in the frataxin protein that is essential for the function of mitochondria, the cellular structures responsible for producing most of the energy cells need to function.

At this time, there isn’t a known cure for the condition, and symptoms will worsen over time. But multiple treatment approaches for FA are available, including a healthy lifestyle, such as eating nutritious foods, and following an approved exercise plan, to help minimize FA’s impact on your body.

And while no data currently supports the existence of a best diet for FA, it’s generally believed a well-balanced, healthy diet rich in a variety of energy-boosting foods and antioxidants is of benefit for someone with FA.

For a person with FA, making smart food choices may have several benefits, including:

• weight management, which can reduce the strain on joints and improve mobility
• less fatigue and increased energy levels
• improved mood and better mental health
• easier bowel movements.

What should an FA diet include?

The diet plan that’s usually recommended for people with FA is similar to what’s recommended for people who don’t have FA. It’s a well-balanced diet that includes eating plenty of fruits and vegetables, whole grains, and lean protein, while limiting highly processed and sugary foods, saturated fats, and salt.

Scientists at the Ataxia Center at the University of California Los Angeles developed what’s known as the ataxia diet, which may help you manage your FA symptoms. The diet avoids processed meats and simple carbohydrates, or carbs that are broken down very quickly and cause spikes in blood sugar, while allowing proteins, healthy fats, and complex carbohydrates, or those that are broken down more slowly and provide more lasting energy.

Components of a healthy FA diet may include:

• Complex carbohydrates, such as unsweetened fruits, starchy vegetables (potatoes, turnips, corn, and peas), rice, pasta, and beans, provide lasting energy to the body.
• Eating enough lean protein, such as seafood, poultry, lean cuts of meat, beans, soy products, and eggs, from a variety of sources helps keep muscles strong and repair damage.
• Eating fresh fruits and veggies, whole grains, and beans offer many benefits of a high-fiber diet, including regular bowel movements, weight management, and improved cardiovascular health.
• Healthy, or unsaturated, fats, such as olive oil, avocados, seeds, and fish, are good sources of energy and are also needed to absorb certain vitamins and antioxidants from other foods.
• It’s recommended FA patients drink six to eight large glasses of water per day for hydration while avoiding sugary drinks such as soda or fruit juices.

Foods to be avoided in FA include:

• simple carbohydrates, such as sweetened drinks, artificial sweeteners, corn syrup, cookies, candies, pastries, and white flour
• processed meats with additives and preservatives, such as bacon, hot dogs, and sausages.

According to the ataxia diet, limiting the amount you eat of certain foods, along with the right exercises, can help to improve your sense of balance. Still, each person will have different tolerance to specific foods, so you and your care team should discuss which ones to eliminate from your diet.

It’s important to always discuss with your doctors your dietary choices, so they can recommend what will be most effective and safe for you. As with many aspects of FA care, determining the right diet may involve several people, including a neurologist, nutritionist or dietician, physical therapist, and speech therapist.

Dietary supplements

Even when following a well-rounded FA diet, some vitamin or mineral supplements may be necessary to help your body get what it needs. A multivitamin, which contains recommended amounts of several key nutrients, may be sufficient, but, in some cases, additional supplements may be needed.

Some important nutrients a doctor might recommend supplementing include:

• vitamin B12, which is needed for blood cells and nervous system health
• vitamin C, which is key for the health of bones, teeth, gums, blood vessels, and immune function
• vitamin D3, which is needed for calcium absorption but is commonly deficient in the general population
• vitamin E, an antioxidant that protects cells from oxidative stress and inflammation
• coenzyme Q10, a powerful antioxidant molecule that plays a key role in energy production
• calcium, a mineral essential for nerve, muscle, and bone health
• magnesium, which helps reduce muscle cramps.

Research on which specific vitamins or minerals may be of particular benefit in a FA diet is limited. In general, a doctor can recommend specific dietary supplements based on whether or not you’re getting the recommended daily amounts of these and other key nutrients from your diet. But every person’s needs will vary, so you should always talk with a healthcare provider before making adjustments.

A few studies have suggested certain nutritional supplements, such as vitamin B3, resveratrol, riboflavin, and coenzyme Q10, may boost frataxin levels and/or ease FA symptoms. However, the findings are still experimental, and more research is needed to establish the possible benefits of these nutrients in FA.

Other considerations

Your specific needs and coexisting conditions, such as swallowing difficulties, diabetes, or heart issues, may also be a factor when creating your best diet for FA management.

Swallowing issues

FA can cause swallowing difficulties, which may increase the risk of choking while eating. If you have swallowing issues, you should avoid certain foods that may be a choking hazard, including:

• foods that are difficult to chew, such as steak or apples
• dry and crumbly foods, such as biscuits or nuts
• small and easily inhaled foods, like sesame seeds
• thin liquids.

Sometimes foods can be modified to make them easier to eat. For example, thin liquids can be thickened with cornstarch or flour to make them easier to swallow. Foods that are difficult to chew can be cut up into smaller pieces.

People with FA should discuss with their healthcare providers, including speech therapists, which foods might be a problem and what modifications can be made.

Diabetes

Up to 10% of people with FA will develop diabetes, which causes blood sugar to get too high.

As in the general population, preventing or managing FA-related diabetes may require dietary changes to keep sugar levels under control. It might involve avoiding sugary foods and simple carbohydrates that can cause sugar levels to spike while eating more foods that help control blood sugar levels, such as ones that are high in fiber.

If you have or are at risk for diabetes, your doctors can help you decide if any dietary changes need to be made.

Heart disease

Heart problems are among the most common FA symptoms, affecting about three-quarters of patients. In the general population, cardiovascular disease is normally associated with poor dietary choices. But the type of heart condition people with FA most commonly have — hypertrophic cardiomyopathy — is not typically related to diet.

Eating a well-balanced and heart-healthy diet can help protect the heart and prevent additional types of heart disease, though it is not likely to prevent the progression of cardiomyopathy.

Friedreich’s Ataxia News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.