Nutrition in Parkinson's disease

Parkinson’s disease is a condition where our brain does not produce enough dopamine. Dopamine is a chemical that regulates our bodily movements and without it,  we will have difficulty controlling our arm, leg, and speech muscles. That’s why the main symptoms of  Parkinson’s are tremor, rigidity and slowness of movement. 

However, Parkinson’s doesn’t only affect movement. People living with Parkinson’s can experience a range symptoms such as depression, constipation, and pain that can have a greater impact on their lives. 

Most people diagnosed with Parkinson’s disease are above 50 years old, but younger people can develop it too. In Singapore, there are currently around 8000 people with Parkinson’s disease, and with our ageing population, the numbers are going up. Parkinson’s disease progresses over time and it’s difficult to predict how quickly this happens. For some, it can take more than 15 years for the condition to reach a point where causes major problems. But for others, it may progress more quickly. 

Unfortunately, there is currently no cure for Parkinson’s disease. With treatment and medication, symptoms can be managed, but they become less effective over time. Everyone affected by this disease experiences a different combination of symptoms – so no two people will follow the exact same medication routine. Parkinson’s is also unique in that it can affect someone differently every day. Symptoms that may be noticeable today may not be a problem the next day.

Nutritional Risk Factors 

You may be wondering, why should nutrition should be of special importance in Parkinson’s disease? This is because good nutrition can make a huge impact in the experience of Parkinson’s disease, even if it has no cure.

By paying attention to their diet, your loved one will feel better, prevent nutrition-related problems, and prevent hospitalisation. As we all are aware, hospital stays can be costly, traumatic for both the patient and their families. By following good nutrition practices, your loved one can stay independant for as long as possible. And as a carer, you will be more able to support him/her in living out a meaningful life for their remaining days. 

In the next section, we’ll share some of the nutrition risk factors that someone with Parkinson’s will face. Following that, we’ll teach you how to tackle them:

1. Parkinson’s causes the gut muscles to slow down. This affects the absorption of medications and nutrients from food. It also causes constipation.
2. Parkinson’s affects the mouth and throat muscles, which in turn causes swallowing problems. As a result, many end up with poor appetite, weight loss and ultimately, malnutrition.
3. With poor appetite, other medical issues such as Diabetes and Hypertension can worsen, which in turn makes it difficult to manage their Parkinson’s.
4. One of the most common medications used to control Parkinson’s symptoms- Levodopa, competes with protein for absorption in the body.
5. People with Parkinson’s may have a higher risk of getting dementia and stroke. There is evidence that good nutrition promotes brain health and protects against them.

Things You Can Do

The symptoms of Parkinson’s disease can vary from day to day. There will be times when your loved one can function almost normally and then other times when they will be very dependent. Listed below are some of the common symptoms and ways to support them through diet and nutrition.

• Constipation
  1. People who don’t drink enough fluids or consume enough fiber can be constipated and have hard stools. This causes a lot of abdominal discomfort. Ensure that fluids are offered regularly throughout the day (at least 1.5 to 2 litres a day) Offer good sources of fibre like whole grain breads and cereals, oats, beans, fruits and vegetables, beans, peas and lentils. Add them to their meals and soups.
  2. When swallowing problems start to emerge, eating fibrous foods may no longer be possible. Therefore, it is important to incorporate dietary fibre supplements so as to maintain digestive health.¹ 
  3. The use of laxatives comes with side effects and results in dependence over time. Instead of relying on laxatives, serve Prune and Pear juice. They are natural laxatives and can help with bowel movements.

• Poor Appetite, nausea and vomiting
  1. One of the symptoms in Parkinson’s is a weakened sense of smell and taste. Therefore, strong-tasting food can help to stimulate appetite. Use flavourful oils, vinegar, soy sauce, curry, chilli to amp up the taste.
  2. If they are eating poorly, make sure that water is given after meals rather than before meals. Otherwise, they might feel too full to eat.   
  3. Offer high-energy snacks throughout the day (e.g. puddings, jellies, buns,  agar-agar, ice cream, egg custard, stewed fruit, local desserts like red and green bean soups, pulut hitam, soybean curd, local snacks like soon kueh, ang ku kueh, yam cake, chwee kueh, chee cheong fun or pastries, croissants, potato chips, chocolates, cream cakes, dimsum etc.) ³
  4. Add peanut butter, jam, honey, or chocolate sauce to their morning porridge to bulk up the calories.
  5. Add margarine and oils, mayonnaise, cream, sour cream, full cream dairy products, dried fruits, nuts, honey, jam to their meals. 
  6. It may be easier to start a meal support service that reduces their risk of malnutrition and allow them to remain happily living in their home. ⁴
  7. Consider nutrition supplements if they are losing weight.
  8. For nausea and vomiting, let them have small frequent meals.
  9. Drinking ginger ale may help to reduce nausea. Include protein at every meal ( e.g. pork, lamb, mutton, beef, chicken, turkey, quail, fish, cheese, yoghurt, nuts, legumes such as baked beans, soybean curd, soy milk, red/green beans, eggs and tofu). 
  10. Promote dairy products such as Milk, cheese and yoghurt which are high in calcium and have protein. Avoid low-calorie, low-fat and low-sugar foods. For a person with poor appetite, the goal is to prevent them from losing weight.

• Swallowing difficulties (Dysphagia)
  1. Make food easier to chew and swallow by changing the texture. Foods that are softer and moist are easier to manage. Mince, chop, grate or mash where needed. ⁴
  2. Use a thickener in water, soups, and beverages. Thicker liquids flow more slowly to prevent choking⁵
  3. Consider home-delivered texture modified meals. This takes away the hassle of cooking and texture-modification. With professionally-prepared meals, you can be assured that it complies with the Dysphagia diet guidelines. ⁴

*If swallowing is a concern, speak to a Speech Therapist. A therapist will be able to assess the problem accurately and teach your loved one exercises to prolong the useful life of his swallowing muscles. Even if there are no swallowing difficulties yet, it is very likely that your loved one has begun to experience speech problems e.g. soft voice and mumbling. These changes in speech is damaging to one’s self-esteem and often causes embarrassment, leading to social isolation. Fortunately, there are very effective treatmentsfor speech problems in Parkinson’s Disease, so please get help as early as possible. 

• Problems moving jaw, lips and tongue
  1. Encourage soft foods, like cooked cereals, soft scrambled eggs, gravies, sauces, thick soups, ground/minced meats or soft stews such as slow cooker meals. ⁴
  2. Try mincing their foods.

• Uncontrolled movements
  1. Parkinson’s drugs can make a huge difference in controlling tremors. Observe how long it takes for the drugs to “kick in” and time your meals shortly after. This gives your loved one the best chance of experiencing an enjoyable meal.
  2. Be flexible and make the most of ‘good eating’ times. Some people eat better at certain times of the day when their movement is less likely to bother them, whether this is at breakfast or later in the evening.
  3. Allow them enough time to eat, do not rush them.
  4. If cutlery is difficult to use, having small portions and finger foods helps them to feed independently (sandwiches, cut up fruits, cheese cubes, fish sticks, chicken nuggets,  diced hard boiled egg, soft vegetables like well cooked broccoli, cauliflower, baked pumpkin/ sweet potato, soft local kuehs/cakes etc). Alternatively, consider a feeding robot that can help your loved one to continue feeding himself in a dignified manner.
  5. Encourage eating in a quiet setting.

• Low blood pressure (postural hypotension)
  1. Large meals can lead to low blood pressure, so stick to smaller portions.
  2. Avoid sugary snacks and drinks (chocolates, biscuits, soft drinks).
  3. Salty snacks may help to maintain the blood pressure ( chips, nuts, soups). *
  4. Sometimes, people find that caffeine can help them avoid low blood pressure ( coffee, diet colas). Avoid caffeine at night, as that can interfere with their sleep.
  5. Having a drink of water before they get up from bed can sometimes help.
  6. Avoid alcohol

* Don’t add extra salt to their diet without speaking to their Doctor or a Dietitian first. It helps to keep a diary of what triggers their symptoms and what makes them better or worse. This will help manage the problem.

Levodopa and Protein

We know that dopamine is important for us as it controls our body movements. That’s why many treatments for Parkinson’s are intended to increase dopamine levels in the brain. For a number of years, the medication Levodopa ( which converts to dopamine in the brain) has been used as the gold standard for treating the symptoms of Parkinson’s. 

However, for somepeople, protein in our food interferes with levodopa absorption. This is because Levodopa and protein both need to utilise “carriers” in order to make the journey from our intestines to our brain. The benefits of protein and Levodopa can only be expressed if they successfully reach our brain.

This means that when our bodies are digesting food that contain a lot of protein, all the carriers in our intestines are “occupied”. There are no empty carriers left to transport Levodopa to our brain and it must wait for its turn. This results in delayed absorption of Levodopa. 

 Thus, it’s helpful for your loved one to:

• Take their medication 30 – 60 minutes before they eat a meal. This will allow the medication to be quickly absorbed before protein can interfere.
• Eating a low-protein snack (such as crackers) when they take their Levodopa. This may  reduce the nausea that Levodopa sometimes causes.
• Take a protein redistribution diet. I.e. Eat most of the protein in the evening. This helps the levodopa treatment to be more effective in the daytime, when your loved one is likely to need it more. 

*Everyone’s Parkinson’s symptoms and drug responses are unique.  If you have any questions about your loved one’s medication or protein intake, their Doctor and Dietitian will always be best persons to provide advice. 

Nutrition in Advanced Parkinson’s Disease 

It is common for people in the later stages of Parkinson’s disease to lose a considerable amount of weight as their symptoms become more debilitating. They may also get dementia and no longer recognise the food they are served. They may:

• Need even more help and become totally dependent for nursing care
• Become increasingly frail and become confined to the bed or wheelchair
• Be completely unable to safely chew or swallow
• Lose control of their bladder or bowels
• Difficulty breathing

In the late stages, deciding on your loved one’s care can be emotionally trying. Please also look after your own mental and physical health. Share your problems, ask for help when needed, and make time for yourself.

* Please read Nutrition in Palliative Care brochure for more information on end-of-life care.

Myths and Facts

Parkinson’s disease only affects someone’s movement.

Many symptoms of Parkinson’s are unrelated to movement. Non-motor (“invisible symptoms”) are common, and may affect everyday life more than the more obvious movement difficulties. These may include: impaired sense of smell, sleep disorders, memory, constipation, bladder symptoms, sweating, sexual dysfunction, fatigue, pain (particularly in a limb), tingling, lightheadedness, anxiety and depression.

My mother doesn’t need to inform her doctor what supplements she is taking.

Supplements can interfere with the effectiveness of conventional medications, which is why it’s important to discuss all dietary supplements she is taking with her Doctor. For example, people with Parkinson’s take supplements like vitamin E, omega-3 fatty acids and coenzyme (CoQ10) for their antioxidant properties. However, in addition to the potential benefits, vitamin E and omega-3 fatty acids may increase the risk of bleeding while coenzyme (CoQ10) may increase blood clotting. These are important risks for people to be aware of, particularly anyone who takes a blood thinner such as warfarin or aspirin, or who is at risk for falling.

Apart from taking his medicines that the Doctor prescribed, there is nothing my Father can do to help his disease.

While it’s true that his Parkinson’s cannot be cured, it is not true that he is merely a passive recipient of life’s circumstances.

By adopting a healthy lifestyle and having strong social support network, we can make a big difference in our experience of illness. In times of hardship, the bonds that we build with our friends and family function like an invisible fortress that keeps us strong amidst the attack of physical illness. That’s why it’s so important to retain one’s communication ability in Parkinson’s disease, and sense of independence. 

Appendix

Helpful Products from Health Food Matters

1. Sunfiber Supplement
2. Special Pantry Snacks and Desserts – Ena Charge Fruit Jelly, Ion Support Fruit Jelly, Soft Fruit Cup, Pureed Fruit, Protein Mousse Dessert, Bread Porridge, Okunosu Nutrition Support Egg Custard  
3. Special Pantry Snacks and Desserts – Soft Fruit Cup, Pureed Fruit 
4. Delisoft Range of dishes available in 4 textures – Regular, Chopped, Finely Minced and Blended textures, Sunfiber Supplement
5. Toromi Smile Clear Beverage Thickener, Special Pantry Thickener Cold Mousse Base powder for making pureed fruits and vegetables

About Health Food Matters 

At Health Food Matters, their team of healthcare experts and food technologist develop scrumptious Delisoft Easy Meals which are nutritious and they come in different textures. They also carry a range of snacks and desserts from their Special Pantry to provide an extra boost for those who struggle getting enough nutrition every day.

About Jaga-Me 

At Jaga-Me we believe in making healthcare accessible and available to everyone. We provide personalised and curated care for your loved ones. If you need a trained nurse to do professional medical procedures, a trained medical escort to accompany your loved ones for their medical appointments or a trained nurse to do nursing procedures, you can engage our care services.

If you found this article helpful, we recommend reading Budget 2019: CHAS Enhancements, Long Term Care Support Funds, MediSave top-ups and How Food is Making a Difference in End-of-Life.

Award winning Home Care trusted by health professionals – Jaga-Me