PARKINSON'S
Parkinson's is a progressive disease that presents with clinical symptoms such as tremor caused by the loss of cells that produce dopamine in the brain, slowness of movements, contractions in muscles.
Parkinson's was first named after the British doctor James Parkinson who identified the disease in 1817. The illness is more prevalent at later ages and can also, albeit rarely, be seen at younger ages. Parkinson's is not contagious. Genetic and environmental factors are believed to be important in the occurrence of the disease. The number of patients suffering from Parkinson's in Turkey is estimated at 100,000.
Dopamine is a chemical substance secreted by nervous cells that control body movements (these cells are called neurons in medicine). These cells are no longer able to produce dopamine when dopamine-secreting cells in the brain are dead and this presents itself as various clinical symptoms that show, particularly in movements. Furthermore, the early stages of Parkinson's may be characterized by symptoms that are not solely exclusive to this disease such as sleep disorders, loss of the sense of smell and constipation.
How is it diagnosed?
Parkinson's disease manifests with clinical symptoms. The four main clinical symptoms are as follows:
- 1- Tremor
- 2- Movement retardation
- 3- Stiffness in arms, legs or abdomen
- 4- Balance problems and falling
The presence of two of these for some time is actually sufficient for an expert to make a diagnosis. The most salient characteristic of the disease is the manifestation of symptoms on only one side of the body. For example, one arm may swing less while moving. Tremors usually occur more while resting. The more Parkinson's disease progresses, the less patients use facial expressions and the more they may start to talk slowly.
However not all tremors point to Parkinson's. In the case of the presence of such clinical symptoms, it is important that the patient be assessed by a specialized doctor and that differential diagnosis be made because starting treatment early is particularly important for this disease.
How is it treated?
Parkinson's is a disease that starts insidiously and progresses though the years. That is why, as is the case with many diseases, early treatment is very important in this illness. Treatment methods may differ based on the clinical state of the patient and their age. Not all patients receive the same treatment and not all patients experience the same type of disease progression.
In reality, the appropriate and accurate use of existing treatment methods by patients under the surveillance of an expert may allow them to carry on their lives without having to detach from it. As is the case in many diseases, treatment methods used in Parkinson's must under no circumstance be discontinued by the patient themselves thinking that "they have healed" without consulting with an expert. There are studies that determine that regular workout has a positive impact on the patient's mood, sleep quality and cognitive functions. Especially at that stage, cooperation between the doctor and the patient's relatives is very important to support the patient, as is the case in many conditions.
The right diet in Parkinson's
There is no particular diet that treats Parkinson's, but a healthy and balanced nutrition provides general wellness. Eating fruits and vegetables will keep you energetic and will prevent dehydration of the body.
Consumption of foods rich in fibers and liquid intake alleviate constipation complaints. Your treatment regimen may affect your diet. Adjusting the timing and content of foods will ensure the treatment is more efficient. To avoid getting affected by the side effects of some particular foods, you must abstain from eating them.
You must work with your doctor and a dietician to determine the best diet for you. For a healthy nutrition program:
- Eat varied food
- Eat healthy portions
- Balance food groups properly
- Eat regularly
- Drink enough water
- Eat fruit at least five times a day
Which dietary changes work in Parkinson's patients?
Constipation is frequent in Parkinson's patients. Increasing the consumption of liquid and fibrous foods regulates bowel movements. Drinking tepid liquid in the morning and drinking 8 glasses of water per day will fasten bowel movements. Fruits, vegetables, wholewheat foods are sources of nutrition and most of these are also antioxidants.
Some Parkinson's drugs have low blood pressure as a side effect. Liquid and salt intake will increase blood pressure but if you have heart and kidney conditions, you must first consult with your doctor. Eating less and frequently will prevent blood pressure fluctuations. Swallowing problems may present as coughing and a sense of sticking in the throat. A speech therapist may make personal dietary changes that are appropriate to you. They may augment foods that enhance the swallowing perception and change the balance between solid and liquid foods.
You must stand straight, eat small bites, chew slowly and keep eating durations long. Some Parkinson's patients may experience painful muscle cramps especially at night and at the end of doses. Consuming yellow mustard, turmeric and drinking sparkling water may help. The right amount of liquid intake may protect from cramps. Taking blood pressure medications towards noon may solve blood pressure fluctuations and vertigos experienced, particularly in the morning. Drinking Turkish coffee in the morning could also help with low blood pressure.
Preserving a healthy weight
A drop in physical activity in Parkinson's may cause weight gain. Being overweight may tire joints and challenge movement. If you put on weight, you must give attention to your diet and the calories you take. For example, you must avoid fried foods, desserts, cakes, biscuits and sugary drinks.
Usually, Parkinson's patients lose weight. If you do, this may be caused by many things such as loss of appetite, difficulty in eating and swallowing, nausea, extra energy spent by the body to deal with involuntary movements (dyskinesia) and a deficient absorption of nutrients by the body. Different pharmacological treatments too may affect body weight.
Finding the right balance
A balanced diet includes varied foods from nutrient groups from the list below. In order to make sure that you consume from all groups throughout the day, you must ideally consume foods from at least three groups. If you are undergoing a specific treatment, this may not always be possible, and you might need to follow the diet that has been prescribed to you.
If you are experiencing involuntary movements, you must take 25-30 calories for each kilogram of your body weight. Carbohydrate protein ratio must be 4-5:1. Daily protein intake must be of 0.8 grams per kilo based on your body weight.
Food Groups
Carbohydrates
Carbohydrates are starch-based and sugary nutrients that respond to the body's principal energy need. Typical carbohydrates include bread, pastry, potatoes, pasta, biscuits, sponge cakes and cakes.
Sugars do not interact with Parkinson's medication but sometimes amino acid cycle may drop due to the fact that sugar increases insulin secretion and medications may have different effects when they reach the brain.
If you have been suffering from Parkinson's for a long time, you may have noticed that carbohydrates and sugary foods worsen and increase involuntary movements, but that at the same time, keeping carbohydrates within your diet is important for you to preserve your body weight and energy levels. You must find a balanced diet that includes all nutrients.
Proteins
Proteins are building blocks for the development and restoration of your body. Typical proteins include meat, dairy products, egg and fish. There are also non-animal-based (plantbased) protein alternatives (legumes).
Fats
The absorption of fats must also be kept under check since they may decrease the absorption of Parkinson's medications due to a retardation of gastric and intestinal elimination. On the other hand, a diet containing large amounts of saturated fatty acids may increase cholesterol and cerebrovascular diseases. Monounsaturated fats (olive oil) and polyunsaturated fats (fish and dried fruits) may be opted for since they play a protective role.
Fiber
Fiber is one of the principal components that must be part of a Parkinson's patient's diet. 30-35 gr of fiber must be consumed every day to decrease constipation. Fiber must be consumed unpulled to ensure they accelerate digestion.
Milk and Dairy Products
Milk and dairy products contain the three main nutritional sources which are carbohydrates, protein and fats. They also contain vitamins and minerals. If you do not consume any dairies, you must make sure you get the main calcium and nutritious substances that are present in dairy products from other sources. Observational data show that there is a correlation between high levels of animal fat and dairy consumption and progression in Parkinson's in men. However, more clinical trials are needed to verify and discover these findings.
Fruits and Vegetables
Fruits and vegetables are a good source of fiber for healthy intestines and against constipation. They also contain some carbohydrates, vitamins and minerals. Fruits and vegetables can be consumed fresh, frozen, canned or dried. Eating high amounts of unsaturated fatty acids and a plant-based diet with fish -which has a low rate of saturated fats- may be preventive against Parkinson's.
Liquids
Drinking 8 to 10 glasses of water per day is very important. Soda and sugary drinks may cause dyspepsia, therefore it is best to avoid these beverages. You must not consume alcohol unless it is prescribed by your doctor.
If you have bladder function issues and have to go to the bathroom often, you must drink liquids in the morning. If you suffer from dryness of the mouth, drinking small quantities of water regularly, sucking on a sugar cube and chewing a gum may be beneficial for dryness of the mouth since these will increase salivation. The more we grow old, the less we need to drink water and some Parkinson's medications may leave the body dehydrated. Thus, drinking water on a regular basis is very important. Meals too can be better eaten and digested when accompanied by water.
Calcium and Vitamin D
Osteoporosis (bone thinning) must especially be avoided in patients with Parkinson's since the risk of fall is high. It is believed that Parkinson's and bone density are linked. That is why, you must evaluate your calcium and vitamin D rates with your doctor and decrease the risk of osteoporosis. To keep your bones strong, you must take at least 1200 mg of calcium and 600IU of vitamin D daily (at age 70 and above, 800IU of vitamin D must be taken). These need can be met by adjusting foods, drinks and supplements.
Good sources of calcium in foods and drinks:are low fat milk, fatty fish and yoghurt. 3 portions of milk or dairy products will meet your daily need of calcium. A portion corresponds to the following:
- One third of half a liter of milk
- 1 small bowl of yoghurt
- 1 matchbox-sized piece of cheese
If you do not like dairy products, the list of products that are not dairies but that do contain calcium is as follows:
- Green-leaved vegetables (e.g., spinach)
- Fillet small fish (such as sardines)
- Legumes such as beans and chickpeas
- Dried fruits
- Dried nuts, tahini
There are different calcium and vitamin D supplements. You can consult with your doctor for recommendations. Strictly do not take vitamin D and calcium supplements without consulting with your doctor. Walk, dance and workout (aerobics) as much as you can. Try to work out for at least 30 minutes a day. Talk with your doctor or physiotherapist on how you can have safe activities in your daily life.
Other vitamins
You must take all of the vitamins and minerals that your body needs by consuming different foods from varied food groups. Instead of taking supplements for the vitamin or mineral that your body lacks, eating the food that contains that specific vitamin or mineral is better, but sometimes your body may not absorb the food well, in that case, taking supplements may be your only alternative. Vitamins A, D, E and K are found in milk and dairy products. These are liposoluble vitamins that can be stored in the body weeks before being consumed. Vitamin B levels have been found to be low in Parkinson's patients. It is believed that maintaining healthy levels of vitamin B6 may decrease the risk of Parkinson's.
B12 vitamin is important for a healthy brain function and maintaining normal levels of vitamin B12 may decrease risks associated with mental problems. Vitamins B and C are watersoluble. The latter is found in citrus fruits, green-leaved vegetables and must be consumed daily because they are not stored in the body.
Minerals
Minerals are found in very small, trace amounts in foods. Important minerals include calcium, chrome, salt, fluoride, iodine, iron, magnesium, manganese, phosphorus, potassium, selenium, sodium, sulphur and zinc.
It is crucial that you consult with your doctor on whether the vitamins and mineral supplements you take interact with other Parkinson's medications. Taking supplements in high amounts may cause other health problems.
Antioxidants
Vitamin E is an antioxidant thought to delay the progress of Parkinson's, however, studies have still to prove it. Antioxidant food sources determined to be of protective nature are vegetable oils, dried nuts, seeds and wheat germ.
Vitamin E supplements do not have any benefits on halting the progression of Parkinson's or restoring motor functions. There is no evidence as to the delaying effect of antioxidants on the progression of the disease. If you have a healthy and balanced diet, you do not need to take any additional antioxidant supplements but if you have problems with your diet, you must consult with your doctor. Taking large amounts of antioxidant supplements may harm your health and may interact with Parkinson's medications.
Colored foods have high antioxidant levels.
- Vegetables: green-leaved vegetables, artichoke, okra, cabbage, pepper, potato
- Fruits: strawberry, pear, apple, grapes, blueberry
- Egg
- Legumes: Beans, Lentils
- Nuts, walnuts
- Dark chocolate (bitter)
- Some drinks such as red wine, coffee and tea
Antioksidanlar
Bazı vitaminler ve mineraller antioksidanlar olarak bilinir ve serbest radikallerin verdiği zararları azaltmaya sebep olur. Antioksidanlar serbest radikalleri durdurarak hücrelerin zarar görmesini engeller.
E vitamini Parkinson’un ilerleyişini yavaşlattığı düşünülen bir antioksidandır fakat çalışmalar bunu henüz kanıtlamamıştır. Yemek kaynaklarından koruyucu olduğu gösterilenler bitkisel yağlar, kuruyemişler, tohumlar ve buğday ruşeymidir. Vitamin E takviyelerinin Parkinson hastalığının ilerlemesini geciktirmek ve motor fonksiyonları düzeltmek ile ilgili bir faydası yoktur. Antioksidanların Parkinson’un ilerlemesini yavaşlatmasıyla ilgili hiçbir kanıt yoktur. Eğer sağlıklı ve dengeli bir beslenme programınız varsa ayrıca antioksidan takviyesi almanıza gerek yoktur ancak beslenme programınızla ilgili sorunlarınız varsa doktorunuza danışın. Antioksidan takviyelerini yüksek miktarlarda almak sağlığınıza zararlı olabilir ve Parkinson ilaçlarıyla etkileşebilir.
Renkli yiyecekler yüksek antioksidan seviyelerine sahiptir.
- Sebzeler: yeşil yapraklı sebzeler, enginar, bamya, lahana, biber, patates
- Meyveler: çilek, armut, elma, üzüm, yaban mersini
- Yumurta
- Bakliyat: fasulye, mercimek
- Fındık, ceviz
- Koyu çikolata (bitter)
- Kırmızı şarap, kahve ve çay gibi bazı içecekler
Co-enzyme Q 10
Co-enzyme Q 10 has high antioxidant properties, but studies do not recommend it as an efficient treatment for Parkinson's. If you want to take Co-enzyme Q 10 additionnally, you must consult with your doctor. Fatty fish, giblets and beef have small amounts of Coenzyme Q 10.
Caffeine
Particularly in men, a specific amount of caffeine intake decreases the risk of progression of Parkinson's disease. Furthermore, consumption of caffeine is recommended because it has preventive properties against Parkinson's.
Parkinson's and poor nutrition
A recent study has shown that 60% of Parkinson's patients are under risk of malnutrition. This does not mean that the entirety of the 60% will have this risk, but it does show that the risk is high. Being aware of all the reasons that cause malnutrition will ensure protection.
Nutrition Problems
Swallowing problems
Swallowing is a complex activity that includes a great number of coordinated phases for pushing food down the stomach. Some Parkinson's patients may suffer from swallowing issues at advanced stages. Difficulty swallowing (dysphagia) in Parkinson's is more pronounced when consuming solid foods than liquids.
- Swallowing problems increase fear and the risk of choking.
- You must consult with your doctor if you have swallowing problems. Your doctor may guide you to a speech therapist or a swallowing therapist. Your swallowing function and risk for chocking should be assessed.
- The therapist may show you safe swallowing methods and explain to you how to eat foods by chopping them into small pieces, mashing them, or how to adjust foods and drinks.
Foods that help with swallowing problems:
It is important to avoid foods that combine the consistency of different foods (such as pasta and soup, jelly with fruit pieces, meat minced with broth, milk and cereals) and foods that are divided into small particles such as rice. Instead, compact large bites of foods should be opted for and may be combined with sauces (such as meatballs in a sauce).
Chewing and swallowing easily
Food allowed for patients with swallowing problems:
- Liquids: Sorbet, jelly, milkshake, liquids containing thickeners
- Bread and cereals: Bread, cooked cereals, toasted bread, pancakes
- Milk and dairy products: Butter, margarine, yoghurt, ice cream
- Fish and meat: Meatballs cooked in a sauce or meatballs, soft meat or fillet fish
- Vegetables: Vegetable mash, steamed or mashed potatoes
- Fruits: Peeled, canned fruits, ripe bananas, fruits in jelly, fruit mash.
Foods that are hazardous for patients with swallowing problems:
- Liquids: Water, light fruit juices, milk, tea, coffee
- Bread and cereals: Crackers, puffed rice, cereals, breads with seeds, dried sponge cakes, biscuits
- Dairy products: Melted cheese
- Fish and meat: Dried or non-fillet fish
- Vegetables: Fresh and long vegetables that require chewing
- Fruits: Fresh fruits
Loss of smell
One of the first symptoms of Parkinson's is the loss of the sense of smell. Smelling is necessary to taste food. Although loss of smell and taste do not usually affect the appetite, they may sometimes be the cause of loss of appetite.
Recommendations: Eat something you like. Focus on the taste concentration of the food.
Lack of appetite, nausea and vomiting
- Medications used in the treatment of Parkinson's usually cause nausea.
- Eat small and frequent servings
- Ginger is quite efficient in reducing nausea
- Keep some fresh ginger in your fridge and use it to make some ginger tea or chew a small piece of ginger
- Keep some ginger with you during travels. You can also use some ginger powder to brew some tea.
Epigastric burning, acid reflux and bloating
- Eat small portions
- Limit your consumption of alcohol, caffeine and sodas or avoid them entirely.
- Sit up straight for 45 - 60 minutes after having eaten.
- Limit your consumption of spicy foods, chocolate, citrus fruit juices, onions, garlic and tomatoes that could trigger the symptoms, or avoid them entirely.
Mistakes made during meals
- Do not skip meals
- Allocate the time necessary for eating
- Prepare small, pre-chopped foods that can be eaten with hands
- Eat in a silent environment
- Do not speak when eating
- If you wield a dessert spoon, you may have less complaints of food going down the wrong way since you won't be able to eat large bites.
Orthostatic Low Blood Pressure (Dizziness encountered when standing up suddenly)
- Avoid eating plenty during meals
- Reduce your intake of glucose-based carbohydrates
- Increase your salt and water intake (consult with your doctor)
- Avoid consuming alcohol
Motor problems in hands
- Stiffness in muscles and loss of manual skills challenge the usage of forks, knives and plates while eating.
- Your doctor may guide you to a therapist that may help you in using a specially designed bowl, glass, spoon, plate that will facilitate your eating.
Poor mood
Depression is prevalent in Parkinson's patients and may affect appetite.
Recommendation: Consult with your doctor on this. Depression may also be linked to deficiencies in vitamin B, vitamin D, omega-3, fatty acids or other nutrients - a blood test will determine whether these deficiencies are present or not, if so, your doctor will help. In some cases, depression can be alleviated by attending regular therapy counseling sessions. However, some people may require anti-depressant medication treatment.
Constipation in Parkinson's
Constipation is a general problem in Parkinson's and adjusting your diet is the most important factor in dealing with it. Constipation is frequently caused by the use of anticholinergic medications and dopamine agonists, as well as by the reduction of mobility. Nearly half of Parkinson's patients declare having a bowel movement less than once per day. Therefore, it is important to increase fiber intake by consuming cooked fruits and vegetables. Since increasing liquid intake will increase liquid absorption in the intestines, it will soften feces and ensure they are more easily passed.
As long as you are not on a fluid restriction diet, it is recommended that your drink at least 1.5 Lt of water per day. Gradually increasing intake of foods rich in fibers such as fruits, vegetables, legumes, lentils, whole wheat breads and cereals will help you with constipation. Too much fiber intake may also cause constipation, you must be careful about this and you must balance fiber and liquid intake.
Eating complex carbohydrates such as whole wheat foods, fruits and vegetables is more beneficial than sugars and processed foods in treating constipation. Workout is also beneficial for stimulating bowels. If you cannot eliminate your constipation problems by changing your diet and increasing your workout routine, consult with your doctor.
Who can advise me on eating problems and dietary programs?
A dietician can create a diet based on nutrition needs. They will prepare a healthy dietary program based on your needs and symptoms and by taking into consideration the Parkinson's medications you take. A speech therapist may give you tactics to help you overcome swallowing and speech problems. They will also help you overcome other possible causes that could create swallowing problems. An tergo therapist will advise you on foods and on the equipment to use for food, thus facilitating mealtimes.
Minor changes in your kitchen and in your dining, area may change everything.
For example:
- If your regroup and gather together the equipment needed for preparing food based on the meal you will prepare, you will not have to move a lot to hold them.
- A blender, microwave and a small knife will ensure the time you spend cooking is shortened since they will ease your task.
How can I help myself?
Recommendations on shopping and preparing food:
- Making a careful preliminary plan will facilitate shopping and the preparation of food. Have enough space in your refrigerator where you can store food. Hence, you'll have spare food when you don't have the opportunity to shop.
