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Eating Well

Parkinson’s affects individuals differently and varies according to how long a person has had the condition, response to treatment, side effects to medications and other pre-existing health issues.

The nutritional issues faced by people living with Parkinson’s are complex and diverse and therefore need to be reviewed by an accredited practising dietician on a case-by-case basis.

Given that Parkinson’s is a progressive neurological condition, nutrient requirements may change through the journey with the condition.

This section will cover:

Staying healthy
Minimising unintentional weight loss
Managing levodopa and meals
Managing your symptoms
Support for you

Staying healthy

A healthy and well-balanced diet is encouraged for people living with Parkinson’s to ensure daily energy and nutrient requirements are met. There is currently no research or evidence to support the use of an alternative dietary therapy or dietary restrictions.

Consuming a well-balanced diet means eating a variety of foods from all the food groups, including whole grains, breads, cereals, fruits and vegetables, meat, legumes, and dairy products.

Useful tips

Eat a variety of fresh fruits and vegetables, including brightly coloured, fresh, in-season produce
Aim for 2 serves of fruit (150g or 1 medium size piece of fruit, 1 cup canned fruit or 2 small plums/apricots) and 5 serves of vegetables per day (75g or ½ cup cooked green or orange vegetables, ½ cup sweet corn, ½ medium potato or starchy veg)
Aim to consume 25-30g fibre per day, along with 1.5-2L of water per day
Establish regular eating patterns, consisting of three main meals and snacks throughout the day
Don’t skip breakfast
Try to include a variety of food from at least three different food groups for each meal. A fun idea is to try and display as many colourful foods on your plate by incorporating a serving of fruit or vegetables, grains, dairy and meat or legumes
Drink plenty of water
Limit your intake of alcohol (<2 standard drinks/day), soft drinks, carbonated drinks, cordials and juices
Try to limit your ‘sometimes’ foods that are higher in kilojoules, saturated fats, added salt and added sugar. For example, pastry and bakery products, processed meats and sausages, ice-cream, confectionary, cream, butter, soft drinks, energy drinks and takeaway deep-fried food

Minimising unintentional weight loss

Unplanned weight loss and malnutrition is more commonly seen in people living with Parkinson’s, with approximately 15% malnourished and up to 34% at risk of malnutrition in the community. Unplanned weight loss not only depletes our body fat stores but also our nutrient and protein stores which makes up our lean muscle tissue.

The adverse effects of losing lean muscle mass can make daily tasks and activities very difficult, such as simple things like walking and maintaining balance. Where permitted, we encourage any form of physical activity (be it endurance or resistance training) to help maintain the muscle mass.

If you are having trouble maintaining or gaining weight, it is important to discuss this with your GP and dietician. A dietician will be able to assess your nutritional status and develop a personalised meal plan and some practical strategies to minimise weight loss that you can implement at home.

Useful tips

Switch from low fat or skim dairy products to full fat dairy products (milk, cheese, yoghurt, custard), this will increase the amount of energy per serving, while not altering the protein content
Plan for three main meals and at least three healthy snacks spread across the day
Have your favourite snacks readily available and within reach. It’s easier to eat the foods that you enjoy than the foods you dislike
Consider adding high energy dense powders into your meals, such as polyjoule
Try to eat your favourite meals when you are feeling best during ‘on times’
Consult an accredited dietician for personalised advice

Managing levodopa and meals

For people with advancing Parkinson’s increased reliance on levodopa and fluctuating motor symptoms, means the timing of your meals with medications starts to play a much more essential role. Levodopa absorption and effectiveness is influenced by the presence of amino acids (found in protein rich foods - meat and poultry, eggs, legumes, nuts, cheese, milk, yoghurt, tofu, lentils, beans).

Therefore, if you consume high protein foods at the same time that you take your levodopa medication, it is likely to result in less levodopa being absorbed and therefore a varied motor fluctuation response. Please note, restricting protein intake does not make levodopa work better, it can vary widely between individuals, as some people may find that certain sources of protein will set them off causing motor fluctuations and some may not.

Protein and your diet

Cutting out wholefood groups, especially protein, is NOT recommended. Foods containing protein provide a valuable source of iron, magnesium, calcium, zinc and vitamin B12. Low protein diets or restricting protein can exacerbate weight loss and malnutrition. The consequence of cutting out protein far outweighs the limited benefits that this can offer. Protein plays an essential role in the body to build the immune system and fight off colds and infections, it helps our body to repair and grow cells, assists in wound healing and helps to maintain lean muscle mass.

Useful tips

If you are experiencing fluctuating motor symptoms, you may benefit from taking your levodopa 20-30 minutes before or after your meals.
If you experience nausea or dizziness with your medication, take it with a carbohydrate drink which is low in protein such as a fruit juice and a cracker or biscuit, to minimise potential side effects which may be experienced in some people if levodopa is taken on an empty stomach
Consult an accredited dietician for personalised advice

A protein redistribution diet

Fine tuning of levodopa and timing of meals becomes more important in the advancing stages of Parkinson’s to optimise levodopa absorption and effectiveness.

There has been some research to support that protein redistribution diets (PRD) improve the effectiveness of the levodopa amongst individuals experiencing more frequent motor fluctuations and worsening motor control (greater ‘off’ time than ‘on’ time). However, the effect of PRDs varies from individual to individual with some patients even experiencing a worsening of motor symptoms.

A protein redistribution diet is where the majority of the protein is consumed later in the day to maximise a person’s ‘on’ time during the daytime hours. PRD needs to be very specifically planned and monitored by a dietician to ensure that adequate energy and nutrient requirements are being met. It is not considered a low protein diet, rather it is a shift of dietary protein towards the end of the day. The amount of protein consumed is the same.

Support for you

If you have any queries or wish to review your current diet (protein intake), consult your GP or dietician. They will be able to assess the appropriateness and safety of a protein redistribution diet for you
A dietician can develop an individual diet regime with specific ratios of carbohydrates to protein, to ensure you get enough energy and all of your nutrient requirements are met

Managing your symptoms

Diet starts to play a much more essential role in the advancing stages of Parkinson’s. We need to adjust our diets to meet our changing nutrient and energy requirements to manage the non-motor symptoms as they become apparent. The symptoms are outlined below with some practical tips to minimise or control symptoms.

Swallowing difficulties

If you are having difficulty chewing or swallowing foods and fluids, it is important to seek advice from a registered speech pathologist.

Useful tips

Take your time to eat and enjoy your meal in a quiet, comfortable environment. If you feel you are taking too long to finish your meals, consider serving your meals on a smaller plate to keep the food warm and going back for seconds
Sit upright when eating and drinking.
Try planning your meals to avoid eating larger meals when you are ‘off’ and maximise eating the food you enjoy while you’re feeling best during ‘on’ times
Some meats can be tough and chewy which makes it difficult to swallow. Try using gravies or sauces and minced meat or slow cooked/stewed meat which is softer and easier to swallow
Try having a drink of water with each meal because it helps to make chewing and swallowing easier. Sipping iced water before beginning to eat may help the strength of your swallow

Managing medication side effects

If you are experiencing fluctuating motor symptoms, nausea or dizziness, inform your doctor and dietician.

Useful tips

If you are experiencing fluctuating motor symptoms, you may benefit from taking your levodopa 20-30 minutes prior to your meals
If you experience nausea and dizziness with your medication, avoid taking it on an empty stomach. Try taking your medication with a glass of fruit juice and cracker or biscuit.

Managing constipation

Constipation is more commonly experienced in people living with Parkinson’s. Making a few dietary changes can improve and relieve your constipation. If constipation persists, inform your doctor and dietician who can discuss the various options for fibre supplementation.

Useful tips

Eat foods higher in fibre, including: all fruits and vegetables (the pips and skins contain lots of fibre), bran, wholemeal breads, cereals, muesli, nuts, pastas, oats, whole grains, beans, and lentils
It is generally recommended that you drink 1.5-2 litres of fluid, spread across the day (tea and coffee count too)
If you are able to exercise safely, try and engage in exercise as often as you can

Dry mouth

Dry mouth and thirst can be an unfortunate side effect of many Parkinson’s medications.

Useful tips

Sip on water or ice chips frequently
Use lip balm regularly to moisten lips and prevent from drying
Avoid using mouthwashes containing alcohol
Try the Biotene range which can be purchased at your local pharmacy

Delayed gastric emptying

This condition results in food remaining in the stomach for an abnormally long period of time. It is associated with nausea, gastric oesophageal reflux disease, feelings of fullness, pain, bloating and a reduced appetite.

Useful tips

Try to include smaller, more frequent meals spread across the day to minimise the stomach becoming overfull
Avoid high fatty meals such as deep-fried, takeaway foods, which delay the stomach from emptying
Avoid soft drinks and carbonated drinks
Avoid lying down within 2 hours of consuming a meal

Eating difficulties

If you are having difficulties using the kitchen utensils, an occupational therapist can advise you on the right equipment for your needs.

Useful tips

Sit upright when eating and drinking
Plan ahead for 3 main meals and 3 snacks spread across the day
Have easy, prepared snacks available and accessible, within reach!
Make sure any dentures are fitted correctly
If you are having problems with the consistency or texture of foods or fluids, you would benefit from speaking to a speech pathologist

Heartburn

Heartburn can be prevented by avoiding trigger foods and drinks (alcohol and caffeine are big triggers!)

Useful tips

Antacid medications to relieve heartburn or indigestion should NOT be taken at the same time as your Parkinson’s medication, as it will affect the absorption and effectiveness
Try to limit or avoid alcohol, caffeine and carbonated drinks
Try to limit or avoid foods that may trigger symptoms, such as high fat dishes (deep-fried, takeaway foods), spicy foods, peppermint, chocolate, citrus juices, onion, garlic, and tomatoes
Avoid lying down within 2 hours of consuming a meal
Avoid a high fatty meal in the evening and focus on the protein content of the meal. For example. Lean roast served with steamed or baked vegetables, or a chicken and vegetable stirfry served with rice or noodles

Support for you

If you are experiencing any of the above nutritional symptoms and require an individualised care plan, speak with your doctor for a referral to see a dietician
On referral from your doctor, Medicare rebates are available to see a dietician under the Chronic Disease Management scheme, previously known as the ‘Enhanced Primary Care’ (EPC) plan
A list of Accredited Practicing Dieticians is available at http://daa.asn.au/for-the-public/find-an-apd/
Contact the Fight Parkinson’s Information Line on 1800 644 189
Email: info@parkinsons-vic.org,au

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