PARKINSON’S DISEASE : NUTRITION MATTERS SUSAN BERKOW, PH.D. CNS PRESIDENT SEB ASSOCIATES ADJ PROF...

PARKINSON’S

DISEASE : NUTRITION

MATTERSSUSAN BERKOW, PH.D. CNSPRESIDENT SEB ASSOCIATES

ADJ PROF GEORGE MASON UNIVERISITY1211 Tatum Drive

Alexandria, VA 22307susan@susanberkow.comwww.susanberkow.com

P/F 703 660 6556

Why is nutrition so important?

• Swallowing problems

• Weight loss, loss of appetite

• Constipation

• Bone thinning

• Dehydration

• Slows stomach emptying and slows gastrointestinal tract – medication

• Medication interaction

Swallowing problems

• Adequate nutrition

• Weight loss

• Taste, smell, texture may be compromised

• Increased risk for malnutrition

• Recommended Dietary Allowances (RDA)• 1800 Kcal• 3 servings each fruits and vegetables• 6 servings grain• 3 servings dairy• Approximately 5 ounces protein

Unplanned weight loss

• Nausea, loss of appetite, depression, slowed movement

• Can lead to: weakened immune system, muscle wasting, loss of vital nutrients and risk for other diseases

• Loss of 5-10% of normal adult weight – for example, a 150 pound man loses 15 pounds (10%) he will be at increased risk for illness and (death)

Bowel Impaction

• Slowing of colon

• Fiber – 25g/day

• Dry hard feces that are impossible to pass normally

Bone Thinning

• Men and women

• Malnutrition

• Increased risk of falls

• Calcium, magnesium, vit D and vit K

• Exposure to sunlight

• Supplements: 1200mg Calcium, 800 IU vit D.

• Dairy foods, green leafy vegetables, broccoli

• Weight-bearing exercise

Dehydration

• Medications can raise risk

• Can lead to confusion, weakness, balance problems, respiratory failure, kidney failure and death.

• At least 8- 8 ounce glasses water/day

Medications

• Polypharmacy – many medications, some for other conditions

• Nausea

• Appetite loss

• Edema (fluid retention)

• Compulsive eating and weight gain

levodopa• Sinemet, Sinemet CR, Madopar, Dopar, Larodopa, Prolopa, Syndopa

• If you take with meal, may take a long time for need to be absorbed because the stomach takes 1 to 3 hours to empty

• Fat takes even longer to clear the stomach

• Protein from the meal is broken down to amino acids in the intestine.. They have to cross across the intestinal wall to get to the blood. Then they have to cross the “blood-brain” barrier to get into the brain.

• PD meds (levodopa) use the same carrier system as the amino acids – competition

• May be necessary to take care with timing of meds and protein-containing foods.

• Preferably at least 60 minutes before or after a meal

• Nausea• Ginger tea• Ginger ale• Graham crackers

• Controlled release?• So it can be taken with a meal; however it

requires more time to become effective – recommend also taking about 60 minutes before meal.

• Therefore, a meal high in protein combined with Sinemet can seriously interfere with levodopa absorption, particularly at the level of the brain receptors. Research indicates that many people who experience "on-off" fluctua- tions can benefit by adjusting their protein intake.

Protein

• Calculate about ½ gram of protein per pound of body weight. For example is you weigh 150 pounds, that will be about 75 grams of protein per day.

• Divide it into three meals and two to three small snacks. Try for about 20-25 grams of food for each meal and 5 grams in your snack. DON’T worry about every single gram. It will work out over a week.

• Amounts of protein in common foods

• Food Grams Protein (approximate)

• Bread: 1 slice 3 grams

• Meat ,poultry, fish: 1 ounce 7 grams

• Vegetables: 1/2 cup 2 grams

• Fruit: 1/2 cup 0 grams

• Milk: 8 ounces 8 grams

• Yogurt: 8 ounces 9 grams

• Egg: one large 6 grams

• Cheese: 1 ounce 7 grams

• Cooked dried beans, peas• Lentils 1 cup 20 grams

• Peanut butter: 1 tablespoon 4 grams

• Nuts: 4 tablespoons (1 ounce) 4 grams