Minimising Unintentional Weight Loss
Unplanned weight loss and malnutrition is more commonly seen in people living with Parkinsons, with approximately 15% malnourished and up to 34% at risk of malnutrition in the community. Unplanned weight loss not only depletes our body fat stores but also our nutrient and protein stores which makes up our lean muscle tissue.
The adverse effects of losing lean muscle mass can make daily tasks and activities very difficult, such as simple things like walking and maintaining balance. Where permitted, we encourage any form of physical activity to help maintain the muscle mass.
If you are having trouble maintaining or gaining weight, it is important to discuss this with your GP and dietician. A dietician will be able to assess your nutritional status and develop a personalised meal plan and some practical strategies to minimise weight loss that you can implement at home.
Managing Symptoms With Nutrition
- Eat foods high in fibre, such as wholegrain breads or bran cereals, fruits and vegetables, also legumes such as beans, peas and lentils.
- Increase your fluids to make sure your fibre intake works well.
- Try to be physically active each day.
Poor appetite, nausea and vomiting
- Have small frequent meals.
- Take medications with a small meal or snack .
- Drink some ginger ale it may help to reduce nausea.
Heartburn, reflux and bloating
- Limit or avoid alcohol, caffeine and carbonated drinks.
- Sit upright at meals and for 45-60 minutes after eating.
- Limit or avoid foods that may trigger symptoms such as spices, peppermint, chocolate, citrus juices, onions, garlic and tomatoes.
- Avoid using straws and sucking on hard candy to reduce gas and bloating.
Problems swallowing food or thin fluids
- See your doctor if you have problems swallowing foods or liquids. You may need a swallowing assessment.
- Ask your doctor to refer you to a dietitian. The dietitian can suggest some ways to modify the foods you eat and the fluids you drink so that they are right for you.
Problems moving jaw, lips, tongue
- Eat soft foods, like cooked cereals, soft scrambled eggs, gravies, sauces, thick soups, ground meats or soft casseroles.
- Try mincing your foods.
- Allow enough time to eat.
- Have small portions and pre-cut foods or finger foods.
- Eat in a quiet setting.
- Reduce carbohydrate intake, especially single sugars.
- Increase intake of salt.
Study Design And Participant Timeline
This is a randomised controlled superiority study with two parallel groups that will be conducted at the University of Florida in Gainesville, Florida, USA. After a virtual visit and providing informed consent, a parallel design will be implemented with a 2-week prebaseline period to assess preintervention GI function and an 8-week intervention to compare standard of care for constipation to standard of care plus a Mediterranean diet . During the 2-week prebaseline period, participants will begin questionnaires, be instructed to maintain their usual diet and will attend their first study visit . Nutritional and neurological evaluations will be conducted at this visit. Participants randomised to the control group will be provided a handout on recommendations for managing constipation symptoms . Those randomised to the intervention group will be provided the same constipation handout and counselled on the Mediterranean diet. Following the 2-week prebaseline period, all participants will be asked to begin incorporating the dietary recommendations into their daily routine . Participants will return to the study site after 4 weeks and 8 weeks .
Schedule of activities per visit
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Getting The Right Balance
A balanced daily diet will contain a wide variety of foods from the five food groups listed below. Ideally you should eat food from at least three different groups at each meal, making sure that you cover all groups throughout the day. This may not be possible if you take certain medications so always follow any instructions you are given regarding medication and diet.
General dietary recommendations currently include:
- maintaining energy intake at 25-30 kilocalories per kilogram of body weight, with additional calories if you experience dyskinesia
- a carbohydrate to protein proportion of at least 4-5:1
- a recommended daily protein allowance of 0.8g/kg of body weight.
A Protein Redistribution Diet
Fine tuning of levodopa and timing of meals becomes more important in the advancing stages of Parkinsons to optimise levodopa absorption and effectiveness.
There has been some research to support that protein redistribution diets improve the effectiveness of the levodopa amongst individuals experiencing more frequent motor fluctuations and worsening motor control . However, the effect of PRDs varies from individual to individual with some patients even experiencing a worsening of motor symptoms.
A protein redistribution diet is where the majority of the protein is consumed later in the day to maximise a persons on time during the daytime hours. PRD needs to be very specifically planned and monitored by a dietician to ensure that adequate energy and nutrient requirements are being met. It is not considered a low protein diet, rather it is a shift of dietary protein towards the end of the day. The amount of protein consumed is the same.
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A Healthy Parkinsons Diet
While the Mediterranean diet may help people with Parkinsons, it is important to remember that you need to focus on your whole diet and not just a small part of it. Eating healthy in general and making smart dietary decisions is what will make the difference for your overall health and well-being.
A few healthy diet tips are below:
- Reduce sugar intake
- Eat lots of fruits, vegetables and grains
- Eat foods high in fiber
- Drink lots of water
- Avoid consuming saturated fat and cholesterol.
- Consume alcohol in moderation.
- Talk to your doctor about setting up the best diet for you.
Our complete Parkinsons diet guide should help you on your way to setting up your Parkinsons diet to live a healthier life. As always, each individual is different so, please contact your doctor and discuss with them before making any dietary changes.
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Visit Your Doctor More Often
The last and the most important advice we could give is to see your doctor often. Talk to your doctor about your conditions and figure out whether you need to make some changes in your diet to improve your symptoms.
Disclaimer: The information shared here should not be taken as medical advice. The opinions presented here are not intended to treat any health conditions. For your specific medical problem, consult with your health care provider.
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Maintaining A Healthy Weight
Parkinsons may lead to gain weight due to reduced mobility. Being overweight can strain your joints which can in turn make moving around more difficult. If this happens you may be advised to watch your diet and control the calories you consume, for example by avoiding fried foods, sweet desserts, cakes, biscuits and sugary drinks.
More commonly, people with Parkinsons lose weight. If you lose weight this may be due to a number of factors loss of appetite, difficulty eating or swallowing, nausea, using extra energy to cope with symptoms such as dyskinesia or your body may not absorb nutrients efficiently. Various medications may also affect your body weight.
The following suggestions may help increase your calorie intake:
- Try eating four or five small but appetising meals a day, with a snack between each meal.
- Incorporate a little more butter, cream, peanut butter, milkshakes, biscuits, chocolate and dessert, but make sure you take good care of your teeth if you eat a lot of sugary food!
- Add three or four tablespoons of milk powder to half a litre of full cream milk to make it more nutritious.
- Try nutritious drinks specially formulated to easily increase calorie intake.
- Eat food that you like as you are likely to consume more.
- If you find cutlery difficult to use, try to have some meals that you can manage with your fingers or using only a spoon.
Eating When Youre Tired
If you donât have energy for meals later in the day, you can:
Pick foods that are easy to fix, and save your energy for eating. If you live with your family, let them help you make your meal.
Look into a delivery service. Some grocery stores have them. Or you can check if you might be able to get food delivered from your local Meals on Wheels program for free or for a small fee.
Keep healthy snack foods on hand, like fresh fruit and vegetables or high-fiber cold cereals.
Freeze extra portions of what you cook so you have a quick meal when you feel worn out.
Rest before you eat so you can enjoy your meal. And eat your biggest meal early in the day to fuel yourself for later.
Combine Exercise With Diet
Dr. Gostkowski says if you want to feel your best, combine a healthy diet with exercise. Research has shown that regular exercise can improve PD symptoms.
Do exercise that raises your heart rate, Dr. Gostkowski says. Aim for about 30 minutes a day, five days a week. Dont worry about specific exercises. Do an activity you enjoy, as long as it gets your heart rate up. Try brisk walking or biking or more advanced exercise for veteran athletes. I recommend seeing an occupational therapist. They can tailor an exercise program to your needs.
Food Items You Can Easily Consume
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Sample Collection And Analysis
Participants will provide a stool sample at 0, 4 and 8 weeks. Sample collection at week 4 will allow for a secondary analysis point if participant adherence to the intervention is suboptimal in the second half of the study. Stool samples will be collected using a commode specimen collection system . Participants will be instructed to portion approximately 1 g of stool sample into four tubes containing preservative and 3 mm glass beads and vigorously shake. Two samples will be preserved in 3 mL RNAlater and the other two samples will be preserved in 3 mL phosphate-buffered saline solution with a final concentration of 3% protease-free bovine serum albumin, 0.05% Tween-20 and 1% protease inhibitor for microbiota and inflammatory analyses, respectively. Participants will ship the samples overnight to the study site the day of or the following day after collection, and then stored at 80 until processing.
Measurements of intestinal permeability and inflammation
Faecal zonulin will be measured as an indicator of intestinal permeability. Intestinal inflammation will be assessed by measuring faecal calprotectin. Both biomarkers will be measured by ELISA. These inflammatory markers have been observed to be altered with PD and may lead to increased intestinal permeability.
Intestinal microbiota studies
Calcium And Vitamin D Intake
Osteoporosis is particularly important to avoid as falls are common in Parkinsons. It is now thought that there is a link between the severity of Parkinsons and bone density so you should ask your doctor to assess your calcium and Vitamin D to reduce the risk of osteoporosis. Although Vitamin D is not found in food, the following foods may be fortified with Vitamin D:
- Good food and beverage sources of calcium are low fat milk, fortified soy/rice beverages, fortified juice, low fat cheeses and yogurts.
- Good food and beverage sources of vitamin D are low fat milk, fortified soy/rice beverages, fortified juice, fatty fish, and fortified yogurt.
- There are many different kinds of calcium and vitamin D supplements. Ask your pharmacist for advice on the different kinds available. If you unable to move around, do not take calcium or vitamin D supplements without consulting your doctor.
Do as much weight-bearing exercise as you can, such as walking, dancing, or aerobics. Aim for 30 minutes or more of activity per day as often as you can. Talk to your doctor or physiotherapist on how to safely include activity into your lifestyle.
Other vitamins and minerals
Vitamins A, D, E and K tend to be found in milk and dairy food and are fat-soluble, which means that they remain in the body for some weeks before being used or expelled.
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Add Medication For A Winning Combo
Diet and exercise are important for managing PD, but dont forget about medications. Take them regularly and exactly as your doctor prescribes.
If you tend to forget your medication, set an alarm to remind you. You can also use a pillbox thats labeled with days and times of day. Take your meds on a set schedule, dont skip doses and dont double dose, says Dr. Gostkowski. When youre diligent about taking your medications and following a healthy lifestyle, youll feel your best.
Impact Of Diet On Parkinsons Medications
Taking certain foods may interfere with the efficacy of drugs used in Parkinsons disease. This is especially true for high-protein foods. Their consumption may affect the bodys ability to absorb levodopa, which is the most prescribed drug in Parkinsons disease. Its therefore good to take levodopa 30-60 minutes before eating the high-protein foods.
However, for some patients it causes nausea, and taking levodopa on an empty stomach might not be a good idea. In that case, taking levodopa with a small snack can enhance the absorption of the drug in the blood.
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Shopping And Preparing Meals
Careful planning can make shopping and preparing meals far easier. Keep a good range of foods in your cupboard and freezer that have a long shelf life as these are always a good back up if you are unable to shop as planned.
- Plan meals in advance and write a list of the ingredients before going to the shops, or ask someone to buy ingredients for you.
- Think about how long you can stand preparing your meal and dont decide on a menu that will take longer to prepare than you can cope with.
- If taking the trouble to cook a meal that can be frozen for other days then remember to double or treble the quantity so that you have a few quick and easy meals another time.
- Make use of ready prepared meals as they can be simply reheated and can save on electricity or gas as well as your own energy. Remember that frozen and tinned vegetables and fruit can be just as nutritious as fresh.
- If you like a sleep during the day, take a flask with you so you can have a hot drink when you wake up without going to the kitchen.
- If you do not own a microwave consider buying a small one as meals or snacks can be very simply and quickly cooked or reheated this way.
Tips For Getting Started
Changing your diet can be difficult. Try making one change at a time, like eating a handful of nuts a few times a week or avoiding white bread. Small changes can add up to big benefits.
- Consult with a registered dietician, who can help you plan menus and make shopping lists for preparing nutritious meals that you like and that account for your individual needs and the timing of your medications.
- An occupational therapist can help you explore assistive devicesto make eating and drinking easier.
- If you experience anxiety or depression, talk to your doctor. These symptoms can suppress appetite.
- If swallowing issues are causing problems eating, a speech-language pathologist may be able to help.
I believe that exercise and weight training remain the most essential self-help one can practice, in addition to diet.
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Who Can Give Me Advice On Diet And Eating Problems
Depending on the country you live in your doctor may be able to refer you to any of the following specialists to give advice on diet or eating problems.
- A dietitian can provide advice on all aspects of nutrition and diet. They will advise on maintaining a healthy diet to suit your needs and symptoms, bearing in mind the medications you take
- A speech and languagetherapist will be able to help you with swallowing problems and strategies to overcome these, as well as speech difficulties. They can also help eliminate any other possible causes of swallowing problems
- An occupational therapist will be able to look at ideas and equipment to make food preparation and mealtimes easier .Simple changes to your kitchen and dining area can make all the difference, for example:
- adding grab rails to help you move around safely
- moving the position of equipment so that food preparation tools are grouped together so you dont need to move around as much
- buying a blender, microwave or small chopper, for example, to ease preparation and reduce the amount of time spent manually preparing food.
Data Management And Confidentiality
After informed consent, participants will be assigned a study number for all data collection. Daily, weekly, physical activity, Mediterranean diet adherence and quality of life questionnaires will be administered electronically using Qualtrics Survey Software . Paper questionnaires will be offered and mailed, when requested. Dietary recalls will be administered electronically by the ASA-24. Participants who are unable to complete the dietary recalls electronically will do so over the phone with a trained study coordinator who will enter the diet recall into ASA-24. Any source data and/or questionnaires completed on paper will be entered into a spreadsheet by at least two study coordinators and data will be compared for quality control. Non-identical entries will be corrected using paper source documents. Auditing of source document completion will be completed after each study visit. Data collected during the trial will be deidentified on study closure. Protected health information concerning study data or participants will not be released to any unauthorised third party.
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