Fighting Parkinson’s Disease with Diet

What is Parkinson’s Disease?

Parkinson's Disease (PD) is a progressive neurodegenerative disorder that predominantly affects the loss of nerve cells in a specific area of the brain called substantia nigra. This area of the brain has a critical role in modulating motor movement and chemical signalling which impacts learning, mood, judgement and other processes. This means people living with Parkinson’s Disease can have significant difficulties with motor and cognitive impairment, impacting their daily life. In most populations, 3-5% of Parkinson’s Disease is explained by genetic causes linked to the Parkinson’s disease genes. Other causes of Parkinson’s Disease include having a relative with PD or tremor (although rare) and environmental factors such as pesticides, however it is still largely unknown what causes many cases of PD.

How is it diagnosed and what are the symptoms?

Around 150,000 Australians currently suffer from Parkinson’s Disease. Generally, PD symptoms gradually develop over years therefore sometimes can take years to diagnose as some people misinterpret symptoms.

Progression of symptoms looks very different person to person although the characterising symptoms include:

• Tremors mainly at rest and described as pin rolling tremors in hands

• Slowness of movement (also known as bradykinesia and hypokinesia)

• Limb stiffness (rigidity)

• Gait and balance problems (postural instability)

Parkinsonism is the term used to describe this group of symptoms. People with PD often experience non-motor related symptoms such as depression, anxiety, apathy, hallucinations, constipation, orthostatic hypotension, swallowing problems, sleep disorders, loss of sense of smell and degree of cognitive impairment.

There is no specific test to diagnose Parkinson’s Disease however a neurologist is required to conduct neurological tests and an evaluation of symptoms. Some tests might include magnetic resonance imaging of the brain (MRI brain), a dopamine transporter scan (DaT scan) or blood work to rule out other conditions.

There are 5 stages of Parkinson’s Disease which can be classified using symptoms. Stages 1 & 2 represent early stages with mild symptoms having no to little impact on a person's daily life. Stage 3 is considered mid-stage characterized by loss of balance, worsening of motor symptoms and function is somewhat restricted with mild disability. Stage 4 & 5 indicate a fully developed disability requiring full-time assistance from another person. Often people are bedridden or confined to wheelchairs at this stage.

Is there a cure?

There is currently no cure for PD although there is treatment available to help manage symptoms such as physiotherapy, medication and surgery. It is important a care plan be implemented with a medical team to help manage PD.

What is the relationship between Parkinson’s Disease and Nutrition?

There is no one specific diet that patients should follow to manage Parkinson’s Disease. It is important to maintain excellent nourishment whilst undergoing treatment for Parkinson’s Disease as poor nutritional intake can result in malnutrition which is associated with poorer treatment outcomes and poor quality of life.

Nutritional management of PD can help people manage their symptoms, although some people require alterations to eating patterns due to medications. Common medications used for PD include:

• Levodopa/carbidopa

• Dopamine agonists

• monoamine oxidase-B inhibitors

It is important for patients to read medication side effects and talk to a pharmacist regarding medication usage, however it is important to note the timing of medication and consumption and food intake is very important. Taking levodopa with high protein meals such as meat, fish and legumes can reduce how much of the drug is absorbed therefore reducing the effects of the medication. Research indicates patients taking levodopa/carbidopa should have their medication 30 minutes before or 60 minutes after a meal to ensure the full efficacy of the drug. These medications work best to alleviate symptoms on an empty stomach. It is also important to note taking iron supplements with levodopa can also reduce the effectiveness of the medication.

If you have further questions about PD medications, it is best to talk to your GP about your concerns.

What nutritional strategies can be used to manage symptoms?

National Healthy Eating Guidelines remain the best general advice as they encourage a variety of food including fruit, vegetables, whole grains, meat and low-fat dairy. The Australian Guide to Healthy Eating outlines general healthy eating recommendations. Below are some outlined strategies for managing symptoms associated with Parkinson’s Disease.

Fibre and water

Increasing fibre intake by eating a large variety of whole grains and colourful vegetables can help reduce constipation. The current guidelines suggest adults should consume between 5-6 serves of vegetables each day and 5-6 serves of grains. Having 6-8 glasses of water throughout the day can also ease digestive difficulties and constipation. Having water with your medication can help break down the medication more efficiently and ensure adequate hydration.

Small Frequent Meals

For some people, they find it easier to have 5-6 smaller meals throughout the day to ensure they are eating enough food, but do not feel overwhelmed by eating large meals. This can also help prevent unintentional weight loss.

More Sodium and Less alcohol

People with PD often experience low blood pressure therefore increasing dietary salt can help prevent low blood pressure, preventing sudden drops which may cause falls and dizziness. People with low blood pressure/postural hypotension should also reduce the size of meals and decrease sugar intake as this can redirect distribution of blood flow to the gut, therefore increasing the risk of hypotensive episodes. People should also consider reducing alcohol intake to prevent a further drop in blood pressure.

Vitamin D + Calcium

Vitamin D and calcium help maintain bone health and current recommendations indicate patients should consume Vitamin D supplementation however you should speak to your doctor. Vitamin D can be found in fortified milk and milk products, egg yolks, fatty fish and other fortified products. Osteoporosis is very common among people with PD, therefore increasing vitamin D and calcium intake can reduce the risk of osteoporosis. Aim to have 3 servings of low fat dairy each day.

Nausea

Sometimes changes in medication or the medication itself can cause the onset of nausea. If this is a symptom that is frequently disturbing you, it is best to talk to your doctor who can potentially prescribe anti-nausea medication or it can be helpful to dry consuming dry and bland foods such as some plain biscuits, potato chips or try drinking some ginger ale or broth.

Caffeine

A large number of PD patients often experience daytime sleepiness. Research has suggested 2-4 cups of coffee during the day can help reduce the effects of sleepiness and can help patients sleep better at night.

Dry Mouth

Some patients experience dry mouth as a result of medication side effects. Sucking on ice chips, consuming more liquids and soups can help alleviate the feeling of dry mouth.

MIND Diet

Many studies have indicated the MIND diet (Mediterranean-DASH diet Intervention for Neurodegenerative Delay) can decrease the risk of cognitive impairment for everyone. This diet is rich in whole grains, green leafy vegetables, berries, fish, low-fat dairy, lean meat and olive oil. This diet does not indicate it will prevent the onset of PD or cure symptoms, however it can help manage symptoms. Similarly, snacking on walnuts, cashews or other nuts to promote brain health can have anti-inflammatory benefits.

How can a Dietitian help people with Parkinson's?

A Dietitian can be a really helpful support person in your medical team. Whilst the recommendations below are helpful it can be beneficial to reach out to a Dietitians can help provide dietary one-on-one support for patients who:

• Have trouble maintaining their weight

• Experience frequent side effects from medication

• Experience gastrointestinal symptoms

• Recommend food fortification strategies

• Struggle with taste changes and weight gain following deep brain stimulation therapy

• Help plan nutritious weekly meals around medication timing

• Require therapeutic texture modified diet nutrition advice

• Struggle from the inability to eat, drink and prepare food

Dietitians can also help provide tailored nutrition advice for any other existing conditions a patient may be experiencing. Dietitians can help patients gain access to oral nutrition supplements if they are struggling to meet their nutritional requirements through food intake.

Some patients may experience difficulty swallowing food due to loss of motor function. If you find trouble swallowing food, you may require a speech pathologist referral who will complete an assessment to determine if you require a therapeutic texture modified diet. It is important to note if a patient has been prescribed a therapeutic texture modified diet, failure to adhere to this diet poses significant risks. It is important to discuss these with your medical management team.

Dietitians Top Tips for managing Parkinson’s Disease

It can be overwhelming trying to manage several dietary changes, however it is important to note all changes might not be necessary and can gradually over a long period of time.

Some easy generalised tips are listed below:

• Maintain and monitor your healthy weight

• Follow medicine instructions for timing of medication with meals

• Consume small frequent meals across the day

• Limit sugar and saturated fat intake, instead include healthy fats such as avocado, olive oil and oily fish to reduce risk of cardiovascular disease and cancer.

• Aim to consume a healthy well-balanced diet with foods from all food groups including a variety of colourful vegetables and whole grains everyday

• Eat most of your daily protein at dinner time

• Avoid alcohol consumption

• Keep a list of your favourite foods/snacks

• Keep track of your blood pressure

• Avoid FAD diets and diet advice from non-reputable sources

Other lifestyle modifications

Research indicates varying benefits of lifestyle modifications for PD. Below are some recommendations for improving overall quality of life and symptom management:

• Increase physical activity for people at early stages. Yoga, Pilates and weight bearing activity can help prevent unsteady gait, loss of muscle mass and boost endorphins.

• Keeping up with daily activities and chores. Scientists believe this can help delay degeneration of motor symptoms.

• Work out your brain! This may help the brain maintain neuroplasticity which is the ability to maintain old connections and form new ones in your brain. Puzzles and reading are great ways to increase brain activity stimulation.

• Seeking help. Some advanced stage patients with varying degrees of disability are able to obtain help from a carer who can provide assistance with daily tasks. Resources for accessing care are available through your healthcare provider.

Support for Parkinson’s Disease

Managing your or your loved one’s condition can be scary but it’s important to know you're not alone and there are plenty of resources to support your disease management.

Useful Resources

• Parkinson’s Foundation

• Parkinson’s Australia

• Better Health Parkinson’s Disease

• Parkinson’s NSW

Fight Parkinson’s Australia has a free and confidential hotline you can contact if you require assistance or emotional support during your diagnosis of Parkinson’s Disease.

If you or someone you know has Parkinson's Disease and you are considering changing your diet, you can reach out to the Dietitians at OSCAR Care Group for allied health professional advice managing your disease. If you have any questions about management of PD, you can reach out to your medical management team to discuss these queries.

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