A New Online Resource to Manage Everyday Diet for People with Parkinson's Disease

MILAN, June 21, 2016

Nutrition Therapy in Parkinson’s Disease (PD)

Having a well-balanced, healthy diet is particularly important if you have Parkinson’s. This can help to manage symptoms such as constipation, slow digestion and swallowing difficulties. Eating can be affected by symptoms such as tremor or stiffness and so it may be helpful to use special aids such as cutlery with adapted handles or weighted cups, for example. For some people a reduced sense of smell and taste can affect their pleasure of eating. 

Here are some tips for healthy eating and managing some Parkinson’s symptoms. Each person will have different nutritional needs and these suggestions should not replace advice given by your healthcare team. 

Meal schedule: it is preferable to have small and frequent meals, to avoid overloading the stomach and slowing digestion and to minimise any swallowing difficulties.

Fibre: increasing daily intake of fibre rich foods such as fruit, vegetables, pulses, lentils, wholegrain breads and cereals can help with constipation. 

Proteins: if you notice that you experience ‘off’ periods after you have eaten a meal containing protein, you may want to decrease protein intake in the morning and at lunch, then increase protein intake at dinner. You should discuss this with your doctor or a dietician who is experienced in Parkinson’s.

Meat: reduce meat consumption (but don’t eliminate it completely) and instead eat more fish and pulses. 

It is helpful to keep a Dietary Diary so that you and your care team can look for any correlation between your symptoms and your diet and then adjust your eating habits to better manage symptoms.

Food Categories

CARBOHYDRATES, FATS AND FIBRE

Carbohydrates: sugars in themselves do not interfere with prescribed medications, although they appear, in some cases, to affect their transport to the brain, as a result of increased secretion of insulin which reduces the level of circulating amino acids.

Fats: the intake of fats should be controlled, as they slow down gastric emptying and therefore prolong the absorption time of medication. In addition, a diet rich in saturated fats increases cholesterol and the risk of cerebrovascular disease. Monosaturated fats (olive oil) and polyunsaturated fats (fish and dried fruit) are preferable because of their  protective role.

Fibre: this is a fundamental component of the diet of someone with Parkinson’s and at least 30-35 g of fibre should be eaten daily in order to reduce constipation. Fibre should preferably be insoluble (bran) as this speeds up gastric emptying and passage through the intestine.

WINE AND ALCOHOL

Unless your doctor has advised you not to drink alcohol, this can be consumed in moderation. Clearly, one or two glasses of wine are not harmful to adults, even those with Parkinson’s. Red wine is preferable given its higher content of resveratrol, a potent antioxidant that also boosts the levels of “good” cholesterol. In general, though, alcoholic beverages should be consumed with caution because they widen the blood vessels, in the same way that some prescribed medications do.

WEIGHT GAIN

Although studies more commonly report weight loss, before diagnosis and in the advanced stages of Parkinson’s, some people may be overweight and may have metabolic diseases such as hypertension, hypercholesterolemia and diabetes.

The effect of weight changes on the prognosis and progression of Parkinson’s is still unknown.

WEIGHT LOSS

Weight loss is a common problem in people who have had Parkinson’s for a long time. Many studies, however, show that weight loss often precedes motor symptoms. Unfortunately, the cause of weight loss is still unclear but it is thought to be related to:

• Increase in energy expenditure related to involuntary movements and muscle stiffness

• Loss of appetite due to nausea, poor coordination in getting food into the mouth, chewing and swallowing difficulties

• Reduced intestinal movement

• Some prescribed therapies

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SWALLOWING DIFFICULTIES 

Swallowing is a complex action that includes a number of highly coordinated phases, in order to push the food from the mouth to the stomach. 

In Parkinson’s, difficulty in swallowing (dysphagia) is more pronounced when consuming solid foods than liquid ones. 

Foods to help with swallowing difficulties

It is important to avoid meals that combine different consistencies of food (soups with pasta or croutons, jelly containing pieces of fruit, minced meat in broth, milk with cereals) and foods broken down into small pieces such as rice. Instead, choose foods that form a compact bolus and combine these with sauces (such as meatballs in sauce).

Easy chewing and swallowing
Fluids Bread and cereals Dairy products Meat and fish Vegetables Fruit	Permitted	Dangerous
	Sorbets, milkshakes, jelly, liquids containing thickening agents Bread, cooked cereals, toast, pancakes Butter, margarine, yogurt, ice-cream Stewed meatballs or meatloaf in sauce, tender meat or fish without bones Puréed vegetables, boiled or mashed potatoes with sauce Peeled, pitted canned fruit, mature bananas, fruit in jelly, thick purées	Water, light juices, milk, tea, coffee Crackers, puffed rice, cereals, bread containing seeds, dry cakes, biscuits Melted grated cheese Dry meat or fish with bones Elongated fresh vegetables that need to be chewed Fresh fruit

CONSTIPATION

Changes in bowel function often occur in Parkinson’s. 

Constipation is a common symptom, often linked to the use of anticholinergic drugs and dopamine agonists, and reduced mobility. About half of people with Parkinson’s say they have a bowel movement less than once a day, with a hardening of faeces and increasingly frequent use of enemas or laxatives.

It is therefore important to increase fibre intake by eating cooked fruit and vegetables. If necessary, supplements containing lactulose and psyllium may be used. Unless you are on a fluid restriction regime, it is recommended that you drink at least 1.5 L of water per day and eat low-residue foods such as rice and potatoes occasionally.

10-Day Dietary Plan

In PD, the most important aspect is the daily diet. To help you to have even more possibilities and variety, discover here a 10-day dietary plan.

Ten days normal calorie and low protein diet  go to:

http://www.myperfectdish.eu/upload/files/mpd.pdf

These suggestions are guidelines only. You should consult with your doctor before changing your diet, particularly with regards to the effects of diet on medication.

The website http://www.MyPerfectDish.eu aims to help people with Parkinson's, their relatives and caregivers in taking care of their nutritional requirements in order to help them enjoy tasty food that meets their dietary needs. 

The website is endorsed by the European Parkinson's Disease Association (EPDA) and sponsored by Zambon, and has been designed as an easy-to-use scientific information tool so people living with Parkinson's can be confident that what they are reading is reliable.

http://health.einnews.com/article/331935511/CgQnuBVN8Tm-Kyj6