Nutrition Article by H. Maratheftis

Nutrition and Parkinsons Disease

Parkinson’s disease (PD) is a chronic progressive neurological disorder in which the body’s ability to control voluntary movements becomes increasingly impaired. This may have an effect on one’s daily activities such as walking, dressing, talking or eating.

This article provides information on the importance of nutrition for people with PD and advice on how to improve some nutrition-related problems that may arise.

Following a healthy balanced diet, a Mediterranean diet in fact, is key for optimal health, in maintaining a healthy body weight and also to ensure adequate intake of nutrients; some of which may help to alleviate symptoms of PD, which are discussed further, below.

Mediterranean diet includes plenty of fresh fruit, vegetables, pulses, fish, olive oil, nuts, seeds and limited amounts of processed foods, fatty meats, fried foods and foods high in sugar.

Antioxidants

Antioxidants are a group of vitamins and minerals that can help reduce oxidative stress (or oxidation) in our bodies. Oxidation causes damage to our cells and are known to play a part in the development of diseases such as heart disease, cancer and Parkinson’s.

Antioxidants include vitamins A and C and are found in abundance in fruit and vegetables especially spinach, broccoli, carrots, red and yellow peppers, pomegranate, cantaloupe melon, berries, tomatoes; and Vitamin E which is found in olive oil, nuts, seeds and wheat germ.

It is recommended to include antioxidants in our diet daily, as mentioned above they can prevent the development but also the progression of certain diseases including Parkinson’s.

Unsaturated fatty acids

The Mediterranean diet recommends the consumption of unsaturated fatty acids (‘good’ fats) instead of saturated fatty acids (‘bad’ fats). Unsaturated fatty acids include oily fish (e.g. salmon, fresh tuna, herring, mackerel, trout), nuts, seeds (e.g. pumpkin, sesame, sunflower), olive oil and avocado. Unsaturated fatty acids are important constituents of neuronal cell membranes with neuroprotective antioxidant and anti-inflammatory properties, which have been found to be protective to our heart and against the development of PD.

Nutritional issues in PD

Unintentional weight loss is common in PD patients due to reduced energy intake, as difficulty in feeding occurs, dysphagia (difficulty in swallowing), depression or medication related side effects (which include: dry mouth, nausea, vomiting, loss of appetite, fatigue).

It is advisable to try and maintain weight and reduce weight loss and malnutrition as much as possible, in order to maintain strength and improve mood and mobility.

 

Small tips to help maintain or increase weight:

-          Eat small and frequent meals

-          Add margarine / butter / milk / cream / cheese to soups, mashed potatoes, toast, vegetables, pasta etc.

-           Use nutritious, high-calorie snacks and drinks in between meals (e.g. milk, milkshakes,  peanut butter sandwiches, nuts, avocado, cheese)

-          Have easy to eat desserts (e.g. cake, ice cream, yoghurt,  custard, rice pudding)

Difficulty with feeding – tips that may help:

-          Place food within easy reach

-          Prepare  ‘finger foods’ where cutlery is not needed or use large-handled cutlery

-          Use a non-slip mat or damp cloth underneath the plate / bowl

-          Two- handled cups can be useful, to reduce spillage

 

Difficulty with chewing / swallowing  - tips that may help:

-          Take your time with meals, eat slowly and take small mouthfuls. Chose a comfortable, quiet environment to have your meal.

-          Eat while sitting upright in a chair.

-          Option for soft foods (e.g. soft meats/fish/pasta/vegetables/ mashed potato/cottage cheese/ tuna) rather than tough and chewy foods.

-          Try moistening your foods with gravy or sauces or even sipping some water with meals to aid swallowing.

-          Thickening agents may be used to thicken fluids if advised by a speech therapist.

If swallowing is extremely difficult, a puree diet may be necessary. If a puree diet is recommended you should seek advice from a clinical dietitian to ensure that your meals are adequate in calories, nutrients and fluid intake.

 

Food and drugs interactions

Levodopa is one of the main drugs used for PD. It is important for Levodopa users to know that taking it with a high protein meal can reduce the effectiveness of the drug for some patients.  It is recommended to take Levodopa 45-60 minutes before meals, ideally with a carbohydrate food, like a cracker or slice of bread (to reduce stomach upsets).  If symptoms persist a dietary plan should be followed to allocate protein meals so they do not interfere with the time the drug is taken. This protein redistribution plan should be discussed with a dietitian.

Depending on the combination of medications prescribed to patients, it is also important to be aware of other nutrients that may interfere with the effectiveness of Levodopa. These include vitamin B6 and iron. Therefore patients should seek advice from their doctors if multivitamins have been prescribed.

Another factor reducing the effectiveness of Levodopa, is if the patient is constipated.

Constipation

Constipation is quite common in PD patients either because of reduced peristalsis in the gut, due to reduced mobility or as a side effect of some drugs. PD patients are advised to:

-          Consume a diet high in soluble fibre (e.g. pulses, oats, fruit and vegetables) and insoluble fibre (wholemeal / wholegrain bread, pitta, brown rice, brown pasta).

-          Ensure sufficient fluid, 8-10 cups (2 litres) a day should be consumed in the form of water, squashes, milk, juices, herbal teas.

-          Increase activity such as walking which can help to improve gut function.

Haris Maratheftis