Nutritional Health For All

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Eating Well With Parkinson's Disease

Nutrition has an important role to play in the management of Parkinson’s Disease (PD). On diagnosis of PD there is no need to make special dietary changes, once your current diet is well balanced.

This leaflet will provide information and advice about following a healthy, well balanced diet. Those with PD can experience nutritional issues such as changes in weight and appetite, constipation and brittle bones. This information provides useful information on ways to overcome these problems. It also includes information on diet in relation to PD medications.

So what is a balanced diet?

Good nutrition in PD involves eating regularly, including a wide variety of foods each day. Choose foods from the each of the food groups daily to make sure you are achieving a well balanced diet

Starchy foods: Each of your meals and snacks should have starchy food, such as bread, potatoes, rice, chapattis, yams, pasta, noodles, oats, cornmeal, crackers, toast and breakfast cereals.

Fruit and vegetables: Aim for five servings of fruit and vegetables each day. Choose from fresh, frozen, canned or dried fruit and vegetables.

Dairy products: Aim for three to five servings of milk and dairy foods each day. A serving is a third of a pint of milk, one small pot of yoghurt, or a small matchbox portion of cheese (both reduced-fat or full-fat varieties of milk and yoghurt are good sources of calcium).

Meat, fish and alternatives: Aim for two to three servings each day from this group. Choose from red or white meat, white or oily fish, eggs, beans, pulses and nuts. If you have difficulty in swallowing, smooth peanut butter and scrambled or poached eggs are useful options. Lamb, beef, eggs, beans and pulses will also provide essential dietary iron.

Fatty and sugary foods: These foods can be eaten in moderation. (See ‘A healthy weight’, below,
if weight control is a problem.)

Fluids: It is very important to drink plenty of fluids. Aim for eight to ten cups (six to
eight mugs/glasses) each day of water, fruit juice, squash or milk. Keep tea or coffee to a maximum of 4-5 cups per day as caffeine in these can lead to dehydration. Try eating juicier fruits, such as melon, will also help increase your fluid intake.

A word on alcohol: Unless you have been advised by your doctor not to drink alcohol, a small amount (e.g. sherry, wine or beer) does no harm and may be beneficial, especially if it encourages a normal social life. The Department of Health and Children recommend that men limit their alcohol intake to 21 units per week, and women limit their intake to 14 units per week. One unit is equivalent to 1 glass of stout/lager/cider (284mls), one small glass of wine (100mls) or one pub measure of spirits (35.5mls). Alcohol intake should be limited to 2-3 units per night for women, or 3-4 units per night for men, with some alcohol free days during the week.

A healthy weight

It is important for everybody to maintain a healthy body weight. Being over or underweight can have effects on your well-being. Weight loss can occur due to the extra movements associated with PD. These extra movements can be due to tremor or dyskinesia, both of which can burn up extra energy. If you are prone to extra movement, it may be necessary to increase your calorie intake to avoid weight loss. On the other hand, It is easy to gain weight if you become less active, and continue eating the same amount as before.

Sensible ways to keep your weight under control:

  • Put away the frying pan! Use healthier cooking methods like grilling, baking steaming, microwaving, poaching.
  • Cakes, biscuits, pastries and confectionery are high in sugar and fat. Reduce the number of times you eat these in the week.
  • Unwanted calories from sugary drinks such as regular fizzy drinks and cordials can add up quickly. Use ‘sugar free’ or ‘low calorie’ options instead. Water is the best drink of all.

What if I am underweight?

Sometimes, weight loss can be due to practical problems to do with food preparation and keeping your food hot while you are eating. Loss of the sense of smell is common in PD, which can reduce the enjoyment of food.

See our advice Gaining Weight the Healthy Way on our website for lots of useful tips on putting weight on while staying healthy.

Constipation

Many people with PD find constipation is a big problem. This can be helped by:

  • increasing your intake of fibre-rich foods
  • increasing your fluid intake
  • taking exercise
How does fibre help?
 
Fibre works by absorbing fluid as it moves through your bowel, forming a soft stool that can be passed more easily. When you increase your intake of fibre, it is very important that you drink 8-10 cups (6-8 mugs) of fluid daily.

How to increase your fibre intake:

Increasing your fibre intake means boosting your intake of wholemeal and wholegrain breads and cereals, fruit and vegetables. See our information Dietary Advice for a Healthy Bowel on our website for detailed information on increasing the fibre in your diet.

Many people find that diet alone is not enough to combat constipation. If your doctor has prescribed laxatives, ensure you take them as directed, as constipation can cause your PD medications to fail.

Bone health

People with PD are more likely to get osteoporosis (brittle bone disease). An adequate intake of calcium and Vitamin D is required to keep bones strong and healthy. Calcium is found mainly in dairy foods such as milk, cheese and yoghurt, some tinned fish and fortified cereals and juices. It is important to have at least 3 portions of calcium containing foods per day. Vitamin D is needed to help absorb the calcium that is eaten. The main source of Vitamin D is from the sun via the skin. Older people, people who are housebound or may cover their skin when outside may have a particular need for extra vitamin D from their diet. Foods that are high in Vitamin D include salmon, margarine, eggs, liver, fortified milks and cereals. Try to include some high calcium and Vitamin D foods daily.

Medication

When and how should I take my PD medication?

You should discuss this in full with your GP, consultant or Parkinson’s Disease Nurse Specialist (if you have one). It is important to drink plenty of fluid with your levodopa medication, such as water, squash or juice. This helps with getting the tablets where they need to be in the bowel, so they can be absorbed. However, it is advised that you do not take your PD medication with milk (see next section).

I have heard that protein affects my medication?

In some people, protein (found mainly in meat, fish, chicken, eggs, cheese, yoghurt, milk, nuts, beans and pulses) seems to interfere with the effectiveness of their levodopa medication. Levodopa is an amino acid, and it will have to compete with the amino acid produced from dietary protein. Therefore, most people benefit from taking their levodopa 45 minutes before meals, or 1 and a half hours after meals. It is recommended that large amounts of protein should not be consumed in a single meal. Protein intake should be spread out throughout the day.

If you do wish to review the timing of your protein intake, discuss it with your GP, or ask to see a dietitian.

Can I take antacids?

Antacids (e.g. Rennie or Milk of Magnesia, which are used to relieve discomfort in disorders of the digestive system) should not be taken at the same time as other drugs, since they may impair absorption.

Vitamins, minerals and antioxidants

Eating a well-balanced diet will provide adequate levels of vitamins and minerals for most people. Some vitamins, when taken in large doses can cause severe side effects.

Oxidation is a normal process which occurs in all cells of the body. A substance produced from this process is known to cause damage and play a part in the development of diseases such as heart disease, cancer and PD.

Antioxidants are a group of vitamins and minerals that can help lessen the damage caused by oxidation. Currently, there is no evidence that they will slow the progression of PD or provide an increased effect of drugs. If you are eating well-balanced diet, your antioxidant needs should be taken care of.

Co-enzyme Q10, found in very small amounts, particularly in protein-rich foods, has strong anti-oxidant properties. Due to a lack of scientific evidence, it has been recommended that co-enzyme Q10 should not be used as a therapy for PD.

If you want some more advice about taking vitamin, mineral or antioxidant supplements, speak to a dietitian or your GP. Taking excessive amounts of antioxidant vitamin supplements can adversely affect your health and well-being, and may interfere with your PD medication. You should not commence taking high dose supplements before discussing it with your GP.

For further information visit:

Irish Association of Speech and Language Therapists (IASLT) http://www.iaslt.ie/

 Parkinsons Association Ireland (PAI) http://www.parkinsons.ie

If you require further information about diet and PD, or a referral to a dietitian, please contact your GP, or go to the 'Find a Dietitian' section of our website.

 

Created by Pauline Thomas, MINDI, October 2013

Review date: October 2015

© 2013 Irish Nutrition and Dietetics Institute, INDI. All rights reserved. May be reproduced in its entirety provided source is acknowledged. This information is not meant to replace advice from your medical doctor or individual counselling with a dietitian. It is intended for educational and informational purposes only.

 

 

 

 

 

 

 

 

 

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