Nausea
The
medications that are used to treat Parkinson's commonly
cause nausea. This problem does not occur in the stomach,
but occurs when the medications enter the brain and stimulate
a part of the brain called the vomiting center, as well
as the dopamine receptor sites causing the nausea. The
nausea can occur when you start Parkinsons treatment,
or with dose adjustments or with the addition of other
medications to treat Parkinson's. When Parkinson's treatments
are commenced many people will take medications with meals
which seems to limit the nausea. This is not a long term
strategy as over time in order to get the best effect
from the medications they will need to be taken on an
empty stomach.
Many
people experiencing nausea related to Parkinson's medications
will need to take an anti emetic or anti nausea drug.
The only drug that can be used is Motilium (Domperidone)
other commonly used anti nausea drugs such as Maxolon
or Stematil have the potential to significantly worsen
the Parkinson's symptoms.
Constipation
and Gastric reflux
One
of the symptoms of Parkinson's is a slowing down of the
gastro intestinal tract. This commonly leads to a slow
transit of food through the stomach, often resulting in
gastric reflux and also constipation.
Reflux
and heart burn can be reduced by being aware that some
foods, especially those that are high in fat will take
longer to digest slowing the movement through the alimentary
tract. Many people who are experiencing these difficulties
may need to use medications to reduce the gastric secretions
in the stomach. Walking or sitting upright following meals
will also assist in alleviating this symptom.
To
help manage constipation, dietary fibre can be increased
by adding extra fibre into the diet. This may be achieved
by adding bran or psyllium husks to cereal in the morning
and ensuring that you drink at least 2 liters of fluid
per day (and more in warm weather), unless you have a
condition where you need to restrict fluid. Monitoring
that you are regular and the stool is soft is important.
Constipation is easily treated and may require the addition
of a regular aperient or laxative, which will help avoid
these difficulties. Choosing an agent that will stimulate
bowel movement and make the stool softer is ideal. Advice
on managing constipation can be obtained by talking to
a continence service or the health team at Parkinson's
Victoria
Parkinson's
and Constipation - written by Parkinson's Victoria
and the National Continence Foundation
Loose
stools or diarrhea can occur and is often related to taking
a COMT inhibitor such as Comtan or Stalevo (a drug containing
dopamine replacement therapy and a COMT inhibitor). Episodes
of diarrhea should be investigated to rule out other causes
and to ensure that it is not related to “overflow”, where
loose stools occur due to severe constipation.
Medication
and Meals
Initially
when people start taking medication this is often with
meals as this seems to reduce some of the nausea which
is experienced. In the first few years of treatment this
does not present a problem, however over time medications
may need to be taken on an empty stomach to increase their
effect. The amino acids contained in protein rich foods
can affect the absorption of the dopamine replacement
therapy as they use the same carrier system to transport
the medication and amino acids into the blood and across
the blood brain barrier.
This
does not mean that you need to reduce dietary protein,
rather in order to avoid difficulties medications should
be taken half and hour prior to meals or 45 minutes following
meals.
Managing
weight
Maintaining
a healthy weight is import in Parkinson's. Some people
may experience some weight gain as their activity level
reduces, however many people lose weight following diagnosis.
Weight loss is often associated with nausea - related
to medication. A reduction in the sense of smell which
is also a symptom of Parkinson's can also reduce appetite.
Experiencing some of the symptoms of Parkinson's such
as tremor or muscular stiffness (meaning increasing effort)
will also use additional calories and may lead to weight
loss. Dyskinesia's, which are involuntary movements that
can occur after several years of treatment with dopamine
replacement therapy, can also result in weight loss.
Many
people with Parkinson's may take longer over meals as
it may be more difficult to use cutlery and their swallow
may be more effortful. The nature of saliva and secretions
can also alter, often becoming thicker, which may affect
swallow.
Often
getting some advice from a dietitian will help to manage
weight loss. Other measures such as increasing the calorie
intake of food, having small frequent meals if you need,
and increasing the time taken to eat meals are all potentially
effective strategies.
Swallowing
Difficulties
Difficulties
with swallowing can occur in Parkinsons. The swallow may
be slower and require more effort and concentration while
changes in secretions will affect the lubrication of the
swallow. Swallowing difficulties are best addressed by
seeing a speech pathologist who will be able to assist
in managing secretions and where necessary they can advise
on the best form of meals and consistency to make swallowing
easier and safer.
Some
ways of optimising swallow include minimising distractions
during meals so that you can concentrate more on eating
and swallowing. Taking regular sips of fluid or ensuring
that your food is moist will help lubricate the swallow.
Having smaller frequent meals or avoiding foods that require
a lot of chewing can help if swallowing is affected by
fatigue.
