PD and Water Needs

Kathrynne Holden, M.S., R.D.

Not everyone realizes that water is considered a nutrient. But in reality, it’s quite possibly the most important nutrient of all.Yet, water is so cheap, so plentiful, and so easy to get, that we may take it for granted. We forget all the special things about water that no other drink can match.

Water dissolves the vitamins and minerals weneed. Then blood, which is mostly water, carries them throughout the body.Water also helps lubricate our joints, and acts as a shock absorber inside the eyes and spinal cord. And, when the digestive system changes the food into fuel for the body, a lot of toxins and wastes are produced. Water is the force that carries these wastes out of the body in the breath, the urine, and the fecal matter. Truly, water is a miraculous substance.

Are fluids more important if you haveParkinson’s? Yes, because those with PD are more likely to have constipation.Yet, with PD, there are so many things to think about that I believe the need for fluids often can be forgotten. However, fluids can be one of the most important aspects of dealing with PD.

How does water help constipation? The job of the large intestine, or colon, is to maintain enough water in the stool to keep it soft. But a hard stool is not life-threatening, so the colon has a low priority on water. When there’s not enough water to go around, the colon removes some water from the stool and gives it to other organs – the brain, the kidneys, the bloodstream. The stool becomes dry, hard, and difficult to pass, resulting in constipation. Although constipation has many possible causes, if you don’t drink enough water, constipation is a pretty sure bet.

But if you’re not used to drinking water, start gradually adding a half-glass a day, and work up to 6 to 8 glasses. Your system may take some time to adjust.You could find that you retain water at first, but gradually your body will release the extra fluids and stay at a well-hydrated level.

Urinary tract infections --Another reason to drink plenty of fluids

Bladder and urinary tract infections are common in older adults and people with PD. Why? The thirst sensation is blunted as we age; therefore, we don't feel thirsty, even when we need fluids. Older adults are frequently in a state of mild and prolonged dehydration. This allows bacteria to grow and thrive in the bladder and urinary tract, causing infection.

A large glass of cranberry juice daily, along with at least four (preferably eight) glasses of water, plus any juices or other beverages usually consumed, is a good idea. Cranberry juice can help prevent infections in many cases, and can also help cure them, along with medications. Cranberries contain a substance that makes it difficult for bacteria to adhere to the walls of the bladder and urinary tract.The bacteria are then flushed out by the flow of urine.

Dry mouth, dry eyes, thirst – more reasons why we need fluids

Some people report that they often feel thirsty and sometimes have dry mouth, thick or sticky saliva, and dry eyes. This may be due to anti-Parkinson medications; the anti-cholinergic drugs such as Artane or Cogentin used totreat tremor are particularly known to cause such symptoms. Dry mouth may also be caused by difficulty swallowing, sleeping with the mouth open, or mouth breathing while awake. Be sure you’re drinking plenty of fluids to counteract dry mouth.

Why is dry mouth a problem? Without saliva, bacteria can breed along the gums and cause decay and loss of teeth. Tooth loss may result in the need for dentures, which often don’t fit well or work as well as natural teeth. This sometimes means that food is poorly digested. Dentures can also cause painful sores on the gums, if they don’t fit well.

More on oral health

Other problems that affect dental health may include difficulty brushing, flossing and/or rinsing the mouth due to rigidity of the tongue, jaw and facial muscles. People with PD should discuss good oral care with their dentists. Provide a list of all the medications you use. Your dentist can recommend anartificial lubricant to help keep the mouth moist, if necessary. Also ask whether you need fluoride treatments or rinses.

If you are drinking six to eight glasses of water daily, plus juices and other beverages, yet still feel that your mouth is dry, try sipping water frequently and swishing it around your mouth to keep it moist.You should also report dry mouth to your dentist, who may suggest a fluoride rinse or artificial saliva, or even sugarless chewing gum.

Dry eyes

The automatic blink reflex is diminished in Parkinson’s disease, causing less frequent blinking.This often results in tired, dry, itchy eyes even in a person who drinks plenty of water. Using artificial tears 2-3 times daily, available over-the-counter in pharmacies, is often recommended. Check with your doctor or optometrist to see if this solution might be helpful to relieve dry eyes.

Excessive thirst / no thirst

Feeling very thirsty can be a sign of acute dehydration. Chronic dehydration, on the other hand, doesn’t always cause a feeling of thirst, yet causes many hospitalizations and may even result in death. Chronic mild dehydration, therefore, can be even more dangerous, because it goes unrecognized until it’s too late. Unfortunately, many PD medications can raise the risk for dehydration, both chronic and acute.

Note:The thirst mechanism slows down with age. Unlike the hunger signal that tells us our body needs fuel, thirst awareness may not activate until we’re already dehydrated. Also, older adults are more likely to take medications that change the amounts of sweat and urine produced, including drugs for respiratory conditions, urinary incontinence, diuretics, and PD.

Unless your doctor has ordered a fluid restriction, the best bet is to drink plenty of plain water, a minimum of 4-8 glasses per day. If you drink caffeine containing drinks or alcoholic beverages, be sure to drink extra water.

People with PD have many concerns -- medications and their effects, timing of meals and levodopa, job responsibilities, family concerns, and much more. Sometimes the most basic need of all can be forgotten: the body's need for water.

Signs of dehydration

• Urinary tract infections

• Low back pain

• Mental confusion

• Dizziness

• Fatigue

• Dry tongue, longitudinal furrows in the tongue

• Dry mouth, cracked lips

• Sunken eyes

• Dark urine, infrequent need to urinate

• Difficulty swallowing liquids

• Difficulty speaking

• Upper body weakness

• Weight loss

If you experience dry mouth, dry eyes, or excessive thirst, write down how much water you drink daily, and check to see if you’re drinking enough. If not, try adding half a glass per day until you reach the recommended level.