Dietary Management in Parkinson’s Disease In Parkinson’s Disease (PD), both the symptoms of the disease and side effects of treatment can compromise nutritional intake. This can cause a person with PD to be at considerable risk of developing weight loss and undernutrition. There are special nutritional concerns in PD which should be considered in order to ensure adequate intake of nutrients. For example, swallowing and chewing difficulties, and increased energy needs associated with tremor or rigidity are taken into account in the nutritional care. It is important to have a well balanced diet of carbohydrates, fats, proteins, vitamins, minerals, fibre and water to maintain optimal nutritional status. A well-balanced diet can be achieved by eating a variety of food using the healthy eating pyramid as a guide. Taking frequent, small meals can aid in maintaining optimal weight when appetite decreases. When this fails to be adequate, drinking nutritionally complete and balanced liquid supplements can be useful. Having a nutritionally balanced diet can help to prevent weight and muscle loss, minimize practical difficulties associated with eating or swallowing, reduce the risks of hospital admission due to falls, and reduce drug-related side-effects such as dehydration, constipation and being overweight. Drug therapy has implications on dietary management. A person with PD who is reliant on levodopa (L-dopa) or anticholinergic drugs needs to be aware of the most appropriate timing to consume medication. In addition, dietary reduction or manipulation of protein intake has been suggested to aid in decreasing the long-term effectiveness of drug therapy and thus help in relieving symptoms of PD. There are three dietary components that deserve special attention in the dietary management of PD, Fiber, calcium/vitamin D and protein will be discussed as follow: Fibre Constipation is a common feature of Parkinson’s disease. This occurs as a result of one of the side effects of some anti-parkisonian drugs, reduced mobility, reduce bowel movement, and a lack of fibre and fluid intake. Constipation can interfere with the uptake of drugs such as L-dopa. It is therefore important to have sufficient fluids of approximately 2 liters per day (8 – 10 cups), and to eat fibre-rich foods that are easily managed. For example, include wholemeal bread, soft fruits, vegetables and legumes as part of a meal. Calcium/Vitamin D Adequate intake of calcium and vitamin D helps to prevent the loss of bone density. Lack of vitamin D prevents calcium absorption, which can lead to brittle bones and an increased risk for fractures. This condition is especially dangerous in person with PD, where falls are more common because of gait and balance impairment. Calcium can be obtain through low fat dairy products like milk, cheese and yogurt or soy milk, while vitamin D can be achieved through exposure to sunlight and by consuming fortified products like cereals and bread. Protein As L-dopa is an amino acid (amino acids are the building blocks of protein), it competes with the amino acids of dietary protein for absorption. This competition may prevent full absorption of Ldopa, and reduce the efficacy of L-dopa therapy, especially late in the disease. Dietary recommendations of protein intake is either evenly distributed or redistributed mostly to the
evening meal. This is normally determined by the physician. It is important not to indulge in excessive consumption of protein-rich foods and keep to recommended dietary allowance (RDA) of protein for most adults of 0.8g/kg body weight/day. Evenly distributed protein intake: protein foods (e.g. fish, chicken, meat, milk, and soy) are divided equally between meals, keeping to the limits according to the body weight. Restricting protein and evenly distributing it improves the time a person is mobile throughout the day. This aids in a person who has moderate motor fluctuations. Protein-redistribution diet: the protein foods at breakfast and lunch should be kept equal and no more than 10g and the remaining protein foods taken at dinnertime. This kind of manipulation, where protein is restricted during the day, further improves the amount of time a person is mobile. This may be beneficial for the person with marked motor fluctuations as it allows for an even more-predictable response. The drawback to this diet is that the person is less mobile after dinner. It is important to note that there is a risk of developing protein deficiency in such dietary manipulation if no appropriate nutritional supervision or advice is given. Dietary Implications of drug therapy L-dopa is not absorbed from the stomach but from lower down the digestive tract (small intestine). Any food matter or enzymes in the stomach will not only delay the absorption of the drug but also cause a lesser amount of it to be available. In order to maximize the absorption of drugs, it is preferable to take L-dopa 15 – 30 minutes before meals and not immediately before or after meals. If L-dopa causes nausea or vomiting, it should be taken with a light snack such as crackers and juice. Anticholinergic drugs can cause dry mouth, and they are preferable to be taken before meals. If gastrointestinal side-effects are detected, then the drug should be taken with a light snack or after meals. This is best determined by your physician. Points to take away, Eat a variety of foods using the healthy eating pyramid as a guide. Increase intake in foods that are high in fibre with adequate fluid intake to reduce the occurrence of constipation. Eat more low fat dairy products like milk, cheese and yogurt or soy milk, which are good sources of calcium and obtain more sunlight and eat fortified products like cereals and bread as sources of vitamin D. Avoid over consumption of protein-rich foods and keep within the recommended dietary allowance (RDA) of 0.8g/kg body weight/day. In conclusion, due to the various treatment and disease effects of PD, an individualized nutritional care plan will be required for the patient. A referral to the dietitian by the physician is needed for a complete nutritional assessment so that the necessary dietary interventions, counseling and monitoring can be carried out.
Healthy Eating Pyramid Eat Least
Eat 2 – 3 servings per day
Eat 2 servings per day
Eat 5 –7 servings per day
Eat Most
Eat 2 servings per day