Adopting a healthy lifestyle, which includes maintaining a balanced diet, can greatly benefit people with Myasthenia Gravis (MG) by enhancing their well-being and creating optimal conditions for managing the disease.
For those with MG, this article provides a comprehensive overview of the top 10 science-backed recommendations to help you optimize your dietary choices for better health.
- Eat Healthily
- Ensure Adequate Levels Of Vitamin D3
- Eat Probiotics And Prebiotics Daily
- Prioritize Anti-Inflammatory Foods
- Manage Medication Side-Effects Through Diet
- Incorporate Whole-Food, Plant-Based Meals Or Days
- Try Fufang Huangqi Decoction (If Possible)
- Avoid Fasting
- Follow Tips For Easier Swallowing If Necessary
- Maintain An Healthy Lifestyle
1. Eat Healthily
Adopting an healthy eating routine is important for all people who care about their health, and it is even more important if you have a disease like MG.
So, what does it mean to eat healthily?
Here is a concise summary with practical tips.
Compose Your Meals With Healthy Nutrients
An healthy eating routine is a way of eating that is based on healthy meals, and an healthy meal is a meal that is built on real whole-foods that nourish your body through the following 8 nutrients.
The healthiest sources of carbohydrates are whole and intact grains. Examples are whole wheat, barley, wheat berries, quinoa, oats, brown rice, and foods made with them, such as whole wheat pasta.
The healthiest sources of protein are fish, poultry, legumes, and nuts. On the other hand it is best to limit red meat and fat cheese, and avoid processed meats such as cold cuts and sausages.
The healthiest sources of fat are healthy plant oils like extra-virgin olive oil, nuts, seeds and fatty fish.
A high intake of dietary fiber brings health benefits and lowers the risk of several diseases. Examples of fiber rich foods include: oatmeal, chia seeds, nuts, legumes, blueberries, whole wheat products, quinoa, brown rice, leafy greens like kale, almonds, walnuts, seeds, and fruits with edible skins like pears and apples.
Vitamins are organic substances that our body needs to function properly. Most health organizations identify thirteen vitamins: A, B1 , B2, B3, B5, B6, B7, B9, B12, C, D, E, and K. Eating a varied, balanced diet is important to ensure a proper intake of all vitamins.
Like vitamins, minerals are micronutrients that are needed to our body to function properly. Most health organizations identify sixteen minerals: Calcium, Chloride, Chromium, Copper, Fluoride, Iodine, Iron, Magnesium*, Manganese, Molybdenum, Nickel, Phosphorus, Potassium, Selenium, Sodium, Zinc. Like for vitamins, eating a varied diet is important to ensure a proper intake of all minerals.
* Magnesium is contraindicated in MG patients when administered intravenously as it may cause a Myasthenic crisis. In addition, magnesium supplementation should be used with extreme caution in MG patients due to the potential for exacerbation of symptoms, including precipitation of MG crisis. 
Phytonutrients are natural chemical substances that can be found in plant foods and protect us from chronic diseases. The best way to benefit from the powerful health effects of phytonutrients is simply to include as many plant-based colorful foods in your meals as possible.
Probiotics are foods or supplements that contain live microorganisms that can maintain or even improve the composition of the population of “good” bacteria in our body, which is known as our microbiota. Consuming probiotics is particularly important for MG patients. A few examples of probiotic foods are fermented foods such as yogurt, milk kefir and water kefir, fermented vegetables like sauerkraut and pickles, tempeh, kimchi, miso and kombucha.
Have A Weekly Eating Plan That Can Help You Stay On Track
An healthy eating routine is a way of eating that incorporates many different types of healthy foods. Varying what you eat on a daily and weekly basis is the best way to ensure that your body gets all the nutrients it needs to function properly and fight the disease. Therefore, having a weekly meal plan can help you maintaining an healthy and varied eating routine.
As a rule of thumb, there are certain foods that can be eaten every day, certain others a few times per week, and some others are best avoided or eaten sporadically.
Foods to eat every day
- Whole grains and pseudo-grains
- Nuts and seeds
- Probiotic foods and drinks
Foods to eat a few times per week
- White meat
- Soy products
- Dairy products
Food to avoid or eat sporadically
- Red meat
- Processed meat
- Refined foods, like refined carbs
Some of the recommended diets for MG emphasize eating foods that contain certain micro-nutrients that play a role in muscle contraction like potassium-rich bananas.
However, when following a healthy, balanced and varied eating routine there is no need to focus on a single specific macro or micro-nutrient. In fact, such a varied diet will naturally meet the required daily amounts of the nutrients you need, including potassium.
2. Ensure Adequate Levels Of Vitamin D3
Vitamin D, often referred to as the “sunshine vitamin” plays a crucial role in our health.
The optimal levels of Vitamin D in blood vary among experts, but it is generally agreed that levels should be well above 30 nanograms per milliliter of plasma (30 ng/mL). Some suggest a minimum of 40, while others recommend 60 or even 80. Everyone agrees that up to 100 is the adequate range, and only from 150 onwards should we begin to worry about possible negative effects.  
Recommended Intake Of Vitamin D
The amount of Vitamin D we eat with foods or supplements is measured in micrograms (mcg) or international units (IU). 1 mcg Vitamin D is equal to 40 IU.
The standard Recommended Dietary Allowance for adults 19 years and older is 600 IU (15 mcg) daily for men and women, and for adults >70 years it is 800 IU (20 mcg) daily. This amount, however, has been determined solely as the amount needed to maintain healthy bones and normal calcium metabolism in healthy people. So, it does not account for other health benefits of Vitamin D.  According to several experts, in fact, this official Recommended Dietary Allowance is very low and insufficient to maximize overall health. 
Our bodies naturally produce Vitamin D when exposed to direct sunlight. The amount produced is around 15 to 25,000 international units, which aligns with the optimal level defined by research. However, modern lifestyles often limit our exposure to the sun, leading to widespread Vitamin D deficiency. 
Some nutritious foods that are rich in Vitamin D are fatty fish like salmon, herring and sardines, cod liver oil, canned tuna, egg yolks and mushrooms (in particular if they have been exposed to direct sunlight). However, the amount of Vitamin D we can obtain from food is limited, and it may not be enough to maintain optimal levels.
When sun exposure and diet are insufficient to meet our Vitamin D needs, supplements can be a useful tool. However, it’s important to remember that Vitamin D is fat-soluble and can accumulate in the body, leading to potential toxicity risks if consumed in excess. Therefore, the use of supplements should be done wisely and under the supervision of a healthcare professional.
The official Tolerable Upper Intake Level of Vitamin D, which is defined as the maximum daily intake unlikely to cause harmful effects on health, is 4,000 IU (100 mcg) for adults and children ages 9+.  This limit, however, is being questioned by several experts who believe that a more reasonable daily limit would be 10,000 IU only for Vitamin D supplementation. 
Vitamin D And Sun Exposure
If we can maintain our Vitamin D levels between 60 and 80 nanograms per milliliter of plasma, we are at an optimal level at which Vitamin D needs are met. This level corresponds to a need of about 15-20,000 international units per day. 
Here comes the wonder of nature: our body can produce Vitamin D on its own when exposed to direct sunlight. The maximum amount of Vitamin D that our body can produce is about 20,000 international units. This takes about 15-20 minutes of exposure to the sun in the middle of the day on a nice summer day when leaving at least half of the body surface uncovered (for example the face, arms and legs) and without any sunscreen protection. 
To reach the same production in the morning or late afternoon, it takes about twice as much exposure time. And if we only expose less than half of our body surface, it takes even longer. 
With sun exposure there is no risk of Vitamin D toxicity because our body creates exactly the amount of vitamin it needs and then stops producing it. 
Vitamin D For MG Patients
A 2012 study on 83 participants assessed whether Vitamin D deficiency is present in MG and whether Vitamin D supplementation has beneficial effects on fatigue. The study found that plasma levels of Vitamin D were significantly lower in patients with MG compared to healthy individuals. 
During follow up visits after 2.5-10 months (mean, 6 months) the study observed that supplementing 800 IU/day of Vitamin D3 (cholecalciferol) increased plasma levels of Vitamin D and had a 38% improvement in the MG composite (MGC) score, which is a test used to assess fatigue in MG patients.
Researchers recommended monitoring Vitamin D parameter in patients with MG and supplementation with Vitamin D3 when levels are low.
Vitamin D Blood Test
If you have MG, ask your doctor to prescribe you a blood test to check your Vitamin D levels. Regular checks of Vitamin D levels can be helpful, especially during the winter months when levels are typically lower.
If levels are deficient, supplementation may be necessary. However, the best source of Vitamin D remains the sun, so make sure to spend time outdoors whenever possible.
3. Eat Probiotics And Prebiotics Daily
Recent studies on humans of 2023  and 2022  investigated the role of probiotics in the pathogenesis and clinical course of Myasthenia Gravis (MG), suggesting that regularly consuming probiotic and prebiotic foods may have positive impacts.
These studies found that “the administration of probiotics was able to restore the gut perturbation and improvement of symptoms in MG patients.” 
The role of probiotics in MG has also been explored in a number of studies in animal models. These studies observed that administration of probiotics was able to improve progression of Experimental Autoimmune Myasthenia Gravis (EAMG).  
- Myasthenia Gravis Diet: The Promising Role Of Probiotics & Prebiotics
- The Surprising Health Benefits of Eating Probiotic Foods
4. Prioritize Anti-Inflammatory Foods
Chronic low-grade inflammation has been described as a starting or aggravating factor in MG.  Recent studies found that autoimmune diseases, including MG, are associated with a pro-inflammatory shift of the gut microbiota.  
The following foods have demonstrated anti-inflammatory properties, so if you have MG you may want to consume them regularly.    
List Of Anti-Inflammatory Foods
- Vegetables, such as broccoli, kale, bell peppers, peppers, Brussels sprouts, cabbage, cauliflower, onions
- Green leafy vegetables, such as spinach and collards
- Fruit, especially deeply colored fruits like blueberries, strawberries, and pomegranates; grapes, cherries, apples, tomatoes, citrus
- Fiber-rich foods in general, especially legumes and whole grains such as barley, oats, and bran
- High fat fruits, such as avocados and olives
- Healthy fats like extra virgin olive oil, avocado / peanut / flaxseed / canola oil
- Fatty fish, such as salmon, sardines, herring, mackerel, anchovies, and tuna
- Nuts like almonds, pecans walnuts, and seeds like flaxseeds, pumpkin and sesame seeds
- Spices, such as turmeric, fenugreek, and cinnamon
- Dark chocolate and cocoa, green tea, and coffee (in moderation)
5. Manage Medication Side-Effects Through Diet
Corticosteroid like prednisone may cause a range of side effects.
Some foods can help mitigating side effects of prednisone and other medications.
If you are taking corticosteroid like prednisone or if you feel weak and unable to exercise, then maintaining an healthy weight may be challenging. In this case, you should adopt make an extra effort to avoid overeating.
You don’t need to count calories or weight your food, it may be sufficient to eat slower and focus on your sense of satiety. When you are about to feel full, then it’s the right moment to end your meal.
If you keep adding weight, then you should fine tune your eating routine to eat just a bit less until you see your weight going in the right direction.
If you are on a journey of losing or controlling your weight, weighting you every day can be a good idea. The best time is to weight yourself in the morning as soon as you get off bed and before eating or drinking anything. A 2015 study observed that daily weighing improves weight loss and adoption of weight control behaviors. 
There are several apps available to track your weight, such as Fitbit. By being aware of how your weight evolves in time, and looking at the trend briefly every morning, you’ll be more likely to adopt weight control behaviors.
Prednisone may accelerate the natural bone loss that happens with age.
Both Vitamin D and Calcium are important for bone health.
The Recommended Dietary Allowance (RDA) for calcium for women 19-50 years of age is 1,000 mg daily; for women 51+, 1,200 mg. For pregnant and lactating women, the RDA is 1,000 mg. For men 19-70 years of age, the RDA is 1,000 mg; for men 71+ years, 1,200 mg. 
Studies revealed downsides to high levels of calcium supplementation, but not to calcium obtained through a regular diet. These include an increased risk of kidney stones and an increased risk of heart attack. 
If you can get at least 700 mg of calcium from food and ensure a proper intake of Vitamin D, that should be enough.  If you’re not sure, check with your doctor before taking calcium supplements.
If your MG medication causes diarrhea, the foods you eat and avoid can be critical to your recovery.
Here are some tips that are recommended in case of diarrhea.  
- Liquids: Drinking plenty of liquids is important to stay hydrated and replace the lost fluids
- Probiotics can also help by restoring the microbiota that is put under stress by diarrhea
- Potassium rich foods: Diarrhea can lower potassium levels. Potassium is widely available in many foods, especially fruits and vegetables. Leafy greens, beans, nuts, dairy foods, and starchy vegetables like winter squash are rich sources.  Some of the best choices in case of diarrhea include orange juice, bananas, potatoes, avocados and apricots.
The following recommendations can also help, but they should only followed for the time needed to recover from diarrhea (usually just a few days at maximum). In fact, the following tips may help in case of diarrhea but are not optimal from a nutritional standpoint as they do not provide the body with all the nutrients it needs.
- BRAT Diet: In case of diarrhea you can follow the BRAT diet, which stands for bananas, rice, applesauce, and toast made from white bread. These foods are bland and low in fiber so they won’t aggravate the digestive system. They can also help firm up stool.
- Bland Foods: Additional bland foods that can help are cooked cereal, like oatmeal, cream of wheat, soda crackers, apple juice without added sugar, baked or boiled potatoes
- Salty Foods: Eating a bit more salty than usual can help maintain fluid levels
Some medications can cause stomach upset. In this case, the following foods can help. 
- Ginger can help reduce nausea and vomiting
- Chamomile may help in case of stomach and intestinal discomfort
- Peppermint, in particular when consumed as peppermint oil, may reduce stomach pain, bloating, gas and diarrhea
- Licorice can help in case of indigestion and may also help prevent stomach ulcers. Deglycyrrhizinated licorice root (DGL), which is available as a food supplement, may be useful for relieving stomach pain and indigestion caused by ulcers or acid reflux
- Flaxseed, consumed as grounded flaxseeds, flaxseed meal, or flaxseed oil, can help regulate bowel movements and relieve constipation
- Papaya can improve digestion and may help with ulcers and parasites. Papaya concentrate may help relieve constipation, bloating, and stomach ulcers, while the seeds may help eliminate intestinal parasites.
- Probiotic-rich foods, in particular fermented dairy products, may help regulate bowel movements and provide relief from both constipation and diarrhea
- Drinking enough fluids is important in particular in case of vomiting or diarrhea
If prednisone gives you fluid retention, you may want to reduce or avoid salt, at least temporarily. In this case you should pay particular attention to food labels to identify which foods are rich in salt. Some examples include certain frozen meals, canned soups and vegetables, smoked and cured meats, and salty snacks.
6. Incorporate Whole-Food, Plant-Based Meals Or Days
Eating whole-food plant based meals, including plenty of fruit and vegetables, plays a central role in healthy eating.
If you normally follow an omnivore eating routine, a good way to increase the intake of plant-based foods is to incorporate whole-food, plant-based (vegan) meals or days in your eating schedule.
A 56-year-old female affected by MG and Lambert-Eaton Myasthenic Syndrome experimented a whole-food plant-based diet for 5 months. As a result, she experienced subjective improvement in overall satisfaction with life, quality of life, pain reduction related to fibromyalgia, and generalized symptoms of neuromuscular disease. She also experienced improvements in other chronic medical conditions, such as hypertension and diabetes, and she lost almost 19 pounds weight during the 5 months duration of the study. Subsequently, several of her medications were successfully de-prescribed and de-escalated. 
7. Try Fufang Huangqi Decoction (If Possible)
Traditional Chinese medicine is based on drugs composed of many different herbs with known and unknown active ingredients that can have different medical indications.
Recent studies, found that Fufang Huangqi Decoction can alleviate the symptoms of MG patients and can conduct to dose reductions and discontinuation of medicines taken for MG.  
Fufang Huangqi Decoction Improves MG Symptoms
A 2022 study was conducted on 100 MG patients that were given Fufang Huangqi decoction. 
100ml of decoction, which was mainly composed of Huangqi (Radix Astragali Mongolici), Danggui (Radix Angelicae Sinensis), Gouqizi (Fructus Lycii), Yimucao (Herba Leonuri Japonici), Baizhu (Rhizoma Atractylodis Macroce-phalae), and other constituents, was given orally twice a day (before breakfast and after dinner).
The average treatment time was (15.6 ± 11.5) months (range: 0.5-55 months).
The study concluded that “Fufang Huangqi decoction is effective for the treatment of type I and II MG and improves the associated clinical symptoms. Moreover, this agent is conducive to dose reductions and discontinuation of basic Western medicines, thereby reducing the side effects experienced by patients.”
Another 2022 study investigated the effect of Fufang Huangqi Decoction on the Gut Microbiota in eight patients with Class I or II MG. 
Also in this case, the decoction was taken orally before breakfast and after dinner (100 ml/dose).
The study found that the administration of Fufang Huangqi Decoction improved the patients’ gut microbiota and “achieved remarkable alleviation of symptoms”.
The study also concluded: “Fufang Huangqi Decoction takes effect within 4 weeks, considerably improving symptoms. After the use of Fufang Huangqi Decoction for 3–5 years, symptoms stabilize, and the dose of Western medicine can be lowered to reduce side effects”.
Astragalus Root (Huangqi)
In western countries, it may be challenging to find Fufang Huangqi decoction. However, Huangqi (Radix Astragali Mongolici), which is the main ingredient of Fufang Huangqi Decoction and known as “astragalus root” in English is easy to find.
Search “astragalus root” on Amazon or on Google, or may also find it in pharmacies.
Consumption of astragalus seems to bring several health benefits. Though there’s no official consensus on the most effective form or dosage of astragalus, 9–30 grams per day is typical. 
The studies on MG mentioned above   may suggest trying Astragalus twice a day (before breakfast and after dinner), as this is the main ingredient of Fufang Huangqi Decoction.
However, another study on Astragalus root mentions that ‘Very high doses may suppress the immune system. Hence patients should avoid using astragalus if they are taking immune-suppressing drugs. Pregnant or nursing women should not use the astragalus root. If a person has an immune system disease, such as multiple sclerosis, lupus, rheumatoid arthritis, or another condition known as an “autoimmune disease,” that person should not use the astragalus root.‘ 
As a consequence, you should not initiate supplementation of astragalus root by your own initiative. If you are interested in trying astragalus root alone, you should discuss this with your doctor first.
What To Do If You Don’t Find Fufang Huangqi decoction
Noticeably, the use of Fufang Huangqi decoction was correlated to a significant improvement of the gut microbiota.  This confirms the importance of maintaining an healthy microbiota in case of MG.
The best way to take care of your microbiota is to consume regularly prebiotic and probiotic foods.
In conclusion, if you can not find Fufang Huangqi decoction, which may be difficult in western countries, you may just make sure you focus on eating plenty of prebiotics and probiotics regularly.
8. Avoid Fasting
Different forms of fasting, such as intermittent fasting, are currently on the rise among health-conscious people.
However, there is currently no evidence that this practice is indicated in case of MG.
A 2020 study investigated the effects of fasting (for Ramadan) in 141 MG patients. This is the only study that researched the role of fasting in MG as of today.
Although Ramadan fasting appeared to be safe and well tolerated for most patients with MG, this study didn’t show clear benefits from fasting. Therefore more studies are needed to evaluate safety and efficacy of fasting in people with MG. 
9. Follow Tips For Easier Swallowing If Necessary
In some severe cases, MG may weaken the muscles that are involved in eating and drinking.
These types of issues can be very subjective, so what helps one person does not help another. However, some common recommendations in case of difficulties with eating and drinking are the following.  
- Eat slowly and rest between bites as needed
- Try holding your head in different directions to find which position makes it easier for you to swallow
- Eat several smaller and more frequent meals, rather than a few larger meals
- Eat your main meal in the moment of your day when you have more energy
- Certain plant foods such as vegetables, fruits, and legumes, which are very important for your health, may be difficult to eat. In order to make it easier for you to eat these foods, try cutting them into very small pieces, mash them, or use them to prepare puree.
- With regard to animal proteins, prioritize those that have a tender texture such as fish, chicken, eggs, and low fat dairy products over other harder types of proteins such as beef steak. You can also chop or mince meat to make it easier to chew.
- Moisten solid foods with condiments or sauce of your choice to make them more tender, for example with broth or yogurt
- Prepare smoothies so that you can drink nutrients without chewing
- Avoid dry, crumbly foods that could stick in your throat
10. Maintain An Healthy Lifestyle
Although very important, eating healthily is only one component of a healthy lifestyle.
In order to fight the disease you should also look after other areas of your life that can maximize help you take care of your well being.
Researchers from Harvard University identified the factors that might maximize the chances of a healthier, longer life.
- Adopting an healthy eating routine
- Exercising regularly
- Maintaining an healthy weight
- No smoking
- Having a moderate alcohol intake
- Maximizing sleep quality
- Maintaining positive social connections
- Having a purpose/meaning in life
- Keeping your brain active
 Effect of treatment with Fufang Huangqi decoction (复方黄杞汤剂) on dose reductions and discontinuation of pyridostigmine bromide tablets, prednisone, and tacrolimus in patients with type I or II myasthenia gravis