• Intimacy and Relationships

• Communication in Parkinson's disease

• Healthy eating in Parkinson's disease

  • Parkinson's disease and diet
  • Eating difficulties in Parkinson's disease
  • Create a balanced diet for Parkinson's disease

• Travel and leisure with Parkinson's disease

Parkinson’s disease and diet

The most important dietary advice for a person with Parkinson’s disease (PD) is to eat a healthy, balanced diet, with plenty of fibre and fluids. It’s as simple as that. A routine of three balanced meals a day is a good start, although some people with PD may find it easier to manage more frequent, smaller, meals.

At different times, certain foods, vitamins or unusual diets may be advertised as being able to help PD, but there is no proof that this is the case. One common story is that broad beans (fava beans) are able to help relieve PD symptoms. It is true that broad beans do contain levodopa, but in variable, small amounts, and at nowhere near the level that is found in levodopa medications. The number of beans you would have to eat for them to have an effect would probably make you ill in other ways. This illustrates why anyone who is tempted by any unusual ‘dietary therapies’ should discuss the idea with their medical team. All people who need nutrition support should receive coordinated care from a multidisciplinary team. Members of the medical team who may be able to advise on diet and practical issues with eating include the doctor/specialist, registered dietician, and PD nurse.

Someone who already eats a healthy, balanced diet, may not need to make any dietary changes. However, in some specific cases, there may be other factors to consider.

Weight management

Parkinson’s disease (PD) generally have an effect on body weight. In some people, movement problems mean less exercise, and they find that they put on weight. Excess weight can put a strain on the joints, and make movement difficult, worsening the problems of PD. Therefore, if people do put on a lot of weight, or are overweight already, then they may be advised to go on a calorie-controlled diet.

However, in most cases, people with PD find that they lose weight. Weight loss can occur for several reasons:

• coping with the symptoms of PD can use up a lot of energy
• there may be a loss of appetite
• eating can become more difficult as PD progresses, and meals may be left unfinished
• the body may absorb fewer nutrients

Therefore, people with PD who lose weight often need to be encouraged to eat more calories. Rather than trying bigger portions, smaller tempting meals and snacks at regular times during the day may be more acceptable. High calorie foods like peanut butter, biscuits/desserts and milkshakes can help to increase weight. If more sugary snacks are being eaten to increase the calorie intake, then it is important to brush teeth more often too.

To make sure that weight is kept under control, regular weighing is recommended, with a record kept of any changes.

Food and medication

If levodopa is prescribed, the doctor will give instructions on how each dose should be taken in relation to food. Most other Parkinson’s disease (PD) medications do not have specific instructions for whether they should be taken with or without food.

Some people with advanced PD with motor fluctuations may be advised to alter their protein intake (examples of foods rich in protein include meat, eggs and cheese). Protein can interfere with the uptake of levodopa into the body and the brain and, as a result, reduce the effectiveness of the medication.

Therefore, it may improve matters if the normal daily intake of protein is taken all together in one meal at the end of the day. If this is necessary, foods low in protein, e.g., bread, cereals, vegetables, fruit, clear or vegetable soups (not creamed or containing lentils or peas), spreads (honey, jam, vegemite), sweets and fats, should make up the bulk of the other daily meals.

This prevents the protein interfering with the effect of levodopa during the day. However, it does not help in all cases, and some doctors will not recommend this change in diet. Therefore, the diet should never be altered in this way before speaking to a doctor or registered dietician. Also, it should be noted that although protein may be taken at a different time of day, the total daily amount of protein should not be reduced, as it is needed by the body for repair and to fight infection.

Another way to avoid the ‘protein effect’ is to take levodopa on an empty stomach (1 hour before or after a meal), as long as this doesn’t cause nausea.

As well as protein worsening motor fluctuations, people with advanced disease may find that their dyskinesias become worse after eating foods high in carbohydrate/sugar. However, carbohydrates should not be excluded from the diet – a good overall balance of foods is still recommended, and carbohydrates are needed to maintain body weight and energy levels.

Antioxidants

Antioxidants are a group of vitamins and minerals that can help lessen the damage caused by a normal body process called oxidation. Oxidation occurs inside the cells of the body, and can produce substances known as free radicals, which cause damage to the body and may play a part in conditions such as heart disease, cancer and Parkinson’s disease (PD).

However, there is presently no evidence that intake of antioxidants will slow the progression of PD or increase the effects of PD medications. In addition, anyone consuming a regular well-balanced diet should already have an adequate intake of antioxidants.

Constipation

Constipation is a common problem in people with Parkinson’s disease (PD), because the condition reduces the action of muscles in the bowel. However, it is one problem that can be managed – and remember that the bowels only need to be emptied 3 or 4 times a week.

If relief can be achieved with a natural diet, then that is the ideal and most healthy way. If constipation becomes a more serious problem (ie, less than 3-4 bowel movements/week), then a doctor will be able to recommend medication.

Listed below are some tips for managing constipation using diet alone.

• Eat a diet high in fibre, although not unnaturally so as this can cause other problems such as bloating and flatulence (wind). Introducing one new high-fibre food every three days allows the digestive system to adapt. High fibre foods include:
• wholegrain bread and cereal
• raw fruit (with or without skin, although skin contains more fibre) and dried fruit
• fruit juice, especially prune, pear, or peach
• leafy vegetables like cabbage, cauliflower, broccoli, and celery
• lentils and split peas
• bran (can be added to cereal or casseroles)
• Drink plenty of water (8-10 glasses a day).
• Hot drinks act as laxatives, although avoid too much tea and coffee, as they cause the body to lose water (dehydrating).
• If possible, take regular exercise such as a daily walk.
• Take your meals at the same time every day.

Drinking fluids

Drinking plenty of fluids, 8–10 glasses a day, is beneficial in many ways (remember, coffee and tea are dehydrating, so they don’t provide as much fluid as other drinks). It is an essential part of a healthy diet and helps to relieve constipation.

Although drooling and excess saliva is frequent in Parkinson's disease, saliva production in PD is typically diminished over normal level. Dry mouth is another problem associated with Parkinson’s disease (PD) that can be eased by drinking more fluids, taking frequent sips of water, sucking ice chips or using a mouth spray or oral rinse (pharmacists sell these specifically for dry mouth). Sucking a sweet, or chewing gum, can also help to produce more saliva and relieve a dry mouth.

Unless the doctor advises otherwise, the drinking of moderate amounts of alcohol is allowed in people receiving PD medication.

Osteoporosis

Osteoporosis is a bone wasting disease that is caused by a lack of calcium and/or vitamin D. This leads to bones becoming thin, weak, and prone to breaks. As people with Parkinson’s disease (PD) are less stable on their feet and more likely to fall, preventing osteoporosis is especially important.

People with PD are at a greater risk of developing osteoporosis as they do less weight-bearing exercise (e.g., standing, walking), which helps to promote bone strength. Osteoporosis is also more common in women. If a doctor or dietician thinks it is appropriate, they will recommend some foods or dietary supplements that are high in calcium.