Parkinson's Disease: Eating Right

While there is no special diet required for people with Parkinson's disease, eating a well-balanced, nutritious diet is extremely beneficial. With the proper diet, our bodies work more efficiently, we have more energy, and medications will work properly.

This article addresses the basics of good nutrition. Please consult your doctor or dietitian before making any dietary changes. A registered dietitian can provide in-depth nutrition education, tailor these general guidelines to meet your needs, and help you create and follow a personal meal plan.

The Basics

• Eat a variety of foods from each food category. Ask your doctor if you should take a daily vitamin supplement.
• Maintain your weight through a proper balance of exercise and food. Ask your doctor what your "goal" weight should be and how many calories you should consume per day.
• Include high-fiber foods such as vegetables, cooked dried peas and beans (legumes), whole-grain foods, bran, cereals, pasta, rice, and fresh fruit in your diet.
• Choose foods low in saturated fat and cholesterol.
• Try to limit sugars.
• Moderate your use of salt.
• Drink eight 8 oz. glasses of water per day.
• Ask your doctor about drinking alcoholic beverages (alcohol may interfere with some of your medications).

Medication and Food Interactions

The medication, levodopa, in general, works best when taken on an empty stomach, about ½ hour before meals or at least 1 hour after meals. It should be taken with 4-5 oz. of water. This allows the medication to be absorbed in the body more quickly.

For some patients, levodopa may cause nausea when taken on an empty stomach. Nausea is an uneasiness of the stomach that often accompanies the urge to vomit, but doesn't always lead to vomiting. Therefore, your doctor may prescribe a combination of levodopa and carbidopa (called Sinemet) or carbidopa by itself (called Lodosyn). If nausea is a continual problem, your doctor may be able to prescribe another medication to relieve these symptoms. There are also tips listed below that can help relieve nausea.

Also, ask your doctor if you should change your daily protein intake. In rare cases, a diet high in protein limits the effectiveness of levodopa.

Controlling Nausea

There are several ways to control or relieve nausea, including:

• Drink clear or ice-cold drinks. Drinks containing sugar may calm the stomach better than other liquids.
• Avoid orange and grapefruit juices because these are too acidic and may worsen nausea.
• Drink beverages slowly.
• Drink liquids between meals instead of during them.
• Eat light, bland foods (such as saltine crackers or plain bread).
• Avoid fried, greasy or sweet foods.
• Eat slowly.
• Eat smaller, more frequent meals throughout the day.
• Do not mix hot and cold foods.
• Eat foods that are cold or at room temperature to avoid getting nauseated from the smell of hot or warm foods.
• Rest after eating, keeping your head elevated. Activity may worsen nausea and may lead to vomiting.
• Avoid brushing your teeth after eating.
• If you feel nauseated when you wake up in the morning, eat some crackers before getting out of bed or eat a high protein snack before going to bed (lean meat or cheese).
• Try to eat when you feel less nauseated.

If these techniques do not seem to ease your queasy stomach, consult your doctor.

Relieving Thirst/Dry Mouth

Some Parkinson's disease medications may make you thirsty. Here are some tips for relieving thirst and dry mouth:

• Drink 8 or more cups of liquid each day. But, some people with Parkinson's disease who also have heart problems may need to limit their fluids, so be sure to follow your doctor's guidelines.
• Limit caffeine (contained in coffee, tea, cola, and chocolate) as it may interfere with some of your medications and may actually make you more thirsty.
• Dunk or moisten breads, toast, cookies, or crackers in milk, tea, or coffee to soften them.
• Take a drink after each bite of food to moisten your mouth and to help you swallow.
• Add sauces to foods to make them softer and moister. Try gravy, broth, sauce, or melted butter.
• Eat sour candy or fruit ice to help increase saliva and moisten your mouth.
• Don't use a commercial mouthwash. Commercial mouthwashes often contain alcohol that can dry your mouth. Ask your doctor or dentist about alternative mouthwash products.
• Ask your doctor about artificial saliva products. They are available by prescription.

I am Too Tired to Eat in the Evening, What Should I Do?

If you are often too tired to eat later in the day, here are some tips:

• Save your energy. Choose foods that are easy to prepare. Don't waste all your energy in preparing the meal because then you'll feel too tired to eat.
• Ask your family to help with meal preparations.
• Check to see if you are eligible to participate in your local Meals on Wheels Program.
• Keep healthy snack foods on hand such as fresh fruit and vegetables, pretzels, crackers, high-fiber cold cereals.
• Freeze extra portions of what you cook so you have a quick meal when you're too tired.
• Rest before eating so you can enjoy your meal.
• Try eating your main meal early in the day so you have enough energy to last you for the day.

I Don't Feel like Eating, What Should I Do?

Here are some tips for improving poor appetite.

• Talk to your doctor; sometimes, poor appetite is due to depression, which can be treated. Your appetite will probably improve after depression is treated.
• Avoid non-nutritious beverages such as black coffee and tea.
• Eat small, frequent meals and snacks.
• Walk or participate in another light activity to stimulate your appetite.

Here are some tips to help you eat more at meals.

• Drink beverages after a meal instead of before or during a meal so that you do not feel full before you begin eating.
• Plan meals to include your favorite foods.
• Try eating the high-calorie foods in your meal first.
• Use your imagination to increase the variety of food you're eating.

Here are some tips to help you eat snacks.

• Don't waste your energy eating foods that provide little or no nutritional value such as potato chips, candy bars, colas and other snack foods.
• Choose high-protein and high-calorie snacks. High calorie snacks include: ice cream, cookies, pudding, cheese, granola bars, custard, sandwiches, nachos with cheese, eggs, crackers with peanut butter, bagels with peanut butter or cream cheese, cereal with half and half, fruit or vegetables with dips, yogurt with granola, popcorn with margarine and parmesan cheese, bread sticks with cheese sauce.

How Can I Make Eating More Enjoyable?

• Make food preparation an easy task. Choose foods that are easy to prepare and eat.
• Make eating a pleasurable experience, not a chore. For example, liven up your meals by using colorful place settings and play background music during meals.
• Try not to eat alone. Invite a guest to share you meal or go out to dinner.
• Use colorful garnishes such as parsley and red or yellow peppers to make food look more appealing and appetizing.

Maintaining Your Weight

Malnutrition and weight maintenance is often an issue for people with Parkinson's disease. Here are some tips to help you maintain a healthy weight.

• Weigh yourself once or twice a week, unless your doctor recommends weighing yourself more often. If you are taking diuretics or steroids, such as prednisone, you should weigh yourself daily.
• If you have an unexplained weight gain or loss (2 pounds in one day or 5 pounds in one week), contact your doctor. He or she may want to modify your food or fluid intake to help manage your condition.

Here are some tips for gaining weight.

• Ask your doctor about nutritional supplements. Sometimes supplements in the form of snacks, drinks (such as Ensure or Boost), or vitamins may be prescribed to eat between meals to help you increase your calories and get the right amount of nutrients every day. But, be sure to check with your doctor before making any dietary changes or before adding supplements to your diet. Some can be harmful or interfere with your medication.
• Avoid low-fat or low-calorie products. Unless other dietary guidelines have been recommended. Use whole milk, whole milk cheese, and yogurt.

Here are some high-calorie recipes to try.

Chocolate Peanut Butter Shake

Makes one serving; 1090 calories per serving.

Ingredients:

• 1/2 cup heavy whipping cream
• 3 tablespoons creamy peanut butter
• 3 tablespoons chocolate syrup
• 1 1/2 cups chocolate ice cream

Directions:
Pour all ingredients into a blender. Mix well.

Super Shake

Makes one serving; 550 calories per serving

Ingredients:

• 1 cup whole milk
• 1 cup ice cream (1-2 scoops)
• 1 package Carnation Instant Breakfast

Directions:
Pour all ingredients into a blender. Mix well.

Super Pudding

Makes four 1/2 cup servings; 250 calories per serving.

Ingredients:

• 2 cups whole milk
• 2 tablespoons vegetable oil
• 1 package instant pudding
• 3/4 cup nonfat dry milk powder

Directions:
Blend milk and oil. Add pudding mix and mix well. Pour into dishes (1/2 cup servings).

Reviewed by the doctors at The Cleveland Clinic Neuroscience Center

Edited by Charlotte E. Grayson, MD, WebMD

Disease de jour: vitamin D deficiency

For every month, there is a disease, and in February, it’s vitamin D deficiency. (It’s also Heart Health Month and I’m sure I’ve neglected to mention a slew of others.)

If you haven’t heard, vitamin D — or the lack thereof — is a hot health topic. The McClean, Virg.-based UV Foundation says that people in states above the 37th parallel (read sun-starved) are increasingly susceptible to the affliction.

The Foundation recently targeted a news release to media outlets in the state of Washington, including this newspaper. We didn’t tell them that, despite the winter inversion doldrums of late, Central Washington still gets more than 300 days of sunshine annually.

Vitamin D deficiency has been linked to increasing the risk of heart disease, Parkinson’s disease, rickets and many types of cancer. It’s also the suspected culprit behind winter-time complaints, including fatigue, depression and aches and pains.

- Leah Beth Ward

Want to reach Leah Beth Ward?
E-mail her: lward@yakimaherald.com

Confusion About Mediterranean Cuisine

February 11, 2009, 1:14 pm

What is a Mediterranean diet anyway? This week researchers reported on a link between Mediterranean-style eating and better brain health. But every time a new report emerges on the health benefits of Mediterranean eating, many consumers are left scratching their heads. How could countries that gave us pizza, lasagna, steak frites and lamb souvlaki teach us anything about healthful eating?

Here are answers to some common questions about Mediterranean eating and health.

What foods are included in the typical Mediterranean diet?

Mediterranean eating is focused on simple cooking and includes all the foods you already eat, just in different proportions. The diet is plant-based in nature, with a heavy emphasis on fruits and vegetables, nuts, grains, seeds, beans and olive oil. Eggs, dairy, poultry and fish are consumed regularly, but the portions are smaller than typically consumed in a Western diet. Meat makes only an occasional appearance, and it’s usually added in small amounts to make sauces, beans and pasta dishes more flavorful. Refined sugar and flour and butter and fats other than olive oil are consumed rarely, if at all. Mediterranean eating also typically includes moderate consumption of red wine. One of the key components of Mediterranean eating has to do with the elevation of the meal as a social event. Meals are consumed at leisure with family and friends.

“One of the basic tenets is the enjoyment of food, and respect and pleasure of food,” says Nicki Heverling, program manager for the Mediterranean Foods Alliance, part of Oldways, the nonprofit food issues think tank that has promoted Mediterranean eating for nearly two decades. “When you’re in the Mediterranean, your meals are three hours and you savor your food.”

Why do so many of my recipes for French, Italian and Greek foods have loads of cheese and meat in them?

The Mediterranean eating plan is based on foods that have traditionally been consumed by communities situated along the Mediterranean sea. Many of the recipes we typically associate with Mediterranean countries don’t come from coastal communities, but from regions farther to the north. Today’s Mediterranean diet pyramid is largely based on the dietary traditions of the Greek island of Crete and southern Italy around the 1960s, when rates of chronic disease were among the lowest in the world, and adult life expectancy was among the highest. Unfortunately, many of the communities where the diet was first studied have changed dramatically, a concern chronicled in the recent Times story “Fast Food Hits Mediterranean; a Diet Succumbs.”

How do we know Mediterranean eating is good for you?

The original work that sparked scientific interest in Mediterranean eating habits came from researcher Ancel Keyes at the University of Minnesota. His landmark seven countries study focused on the link between eating habits along the Mediterranean and better health, despite inferior medical care in the region. Research on the diet took off in the 1990s, as scientists noted that people in Mediterranean countries lived longer and had low rates of serious disease despite high rates of smoking and drinking. Last year, the British medical journal BMJ published an extensive review of Mediterranean diet studies. It found that the eating plan is associated with significant health benefits, including lower rates of heart disease, cancer, Parkinson’s disease and Alzheimer’s. More recently, researchers found a link between Mediterranean eating and diabetes risk as well as lower blood pressure. The Oldways Web site offers a lengthy list of studies of Mediterranean eating and health.

Do I really have to eat meat only once a month?

While the traditional diet included meat only about once a month or on special occasions, most health experts say adhering to Mediterranean eating doesn’t have to mean giving up meat. It just means consuming smaller portions less often. If you are packing your diet with produce, nuts, legumes and whole grains, you won’t have a lot of room left on your plate for big servings of meat anyway. “What we try to convey to people is don’t cut anything out of your diet you enjoy,” says Ms. Heverling of Oldways. “Make smaller portions and when you have it, really enjoy it. In the traditional diet, someone wasn’t eating a 12-ounce Porterhouse steak. They ate small bits of meat in a sauce. It was there to get flavor and taste from. Meat is delicious and they knew that.”

How can I learn more about Mediterranean eating?

The Web is filled with resources. Click on the links above, or visit the Oldways Web site to get started. The Mayo Clinic also offers a useful summary of the eating plan. About 150 products are labeled with the Med Mark from the Mediterranean Foods Alliance. And “The New Mediterranean Diet Cookbook: A Delicious Alternative for Lifelong Health” received a starred review from Publisher’s Weekly and includes a foreword by New York University nutritionist Marion Nestle.

Finally, the Mediterranean diet has its own food pyramid. A version can be found on the Oldways site, or below you can find one created by the Greek Health Ministry to explain the diet. They pyramids have some differences but both support the idea that a Mediterranean diet is largely based on plant foods and whole grains.

The Mediterranean Diet (The New York Times)

Coffee drinkers show lower dementia risk

Tue Feb 3, 2009 4:20pm GMT

By Amy Norton

NEW YORK (Reuters Health) - In more good news for coffee lovers, a new study suggests that middle-aged adults who regularly drink a cup of java may have a lower risk of developing dementia later in life.

Whether coffee itself deserves the credit is not yet clear, but researchers say the findings at least suggest that coffee drinkers can enjoy that morning cup "in good conscience."

The study found that among 1,400 Finnish adults followed for 20 years, those who drank three to five cups of coffee per day in middle-age were two-thirds less likely than non-drinkers to develop dementia, including Alzheimer's disease.

The findings, reported in the Journal of Alzheimer's Disease, add to a string of studies finding that coffee drinkers have lower risks of several diseases, including Parkinson's disease, certain cancers and diabetes.

No one is recommending that people start drinking coffee to ward off any disease, however. Researchers do not know if it's components of coffee itself -- like caffeine or certain antioxidants -- or something else about coffee drinkers that explains the recent study observations.

The current study was an epidemiological one, explained lead researcher Marjo H. Eskelinen, which means it can point to an association between coffee and dementia risk, but does not prove cause-and-effect.

Still, "the results open a possibility that dietary interventions could modify the risk of dementia," Eskelinen, a doctoral candidate at the University of Kuopio in Finland, told Reuters Health.

There are a few potential reasons why coffee could help stave off dementia, researchers point out. One reason is related to the fact that coffee drinkers may have a lower risk of type 2 diabetes, and diabetes, in turn, is linked to a higher risk of dementia.

Coffee also contains plant chemicals, such as chlorogenic acid, that act as antioxidants and may help protect body cells from damage over time. For its part, caffeine may have a protective effect on brain cells because it blocks receptors for a chemical called adenosine, which has depressant effects in the central nervous system.

More research is needed to determine whether coffee is truly protective, but for now, Eskelinen said, "those people who have been drinking coffee can still do so in good conscience."

SOURCE: Journal of Alzheimer's Disease, January 2009.