Lifestyle impacts your health.

James Parkinson first described the disease which came to bear his name in 1817. It is a neurodegenerative disease (damges brain and nerve cells) with symptoms that include:

• tremors
• muscular stiffness
• difficulty with balance and walking

Medical testing finds the presence of an inclusion body, called the Lewy body, in many regions of the brain.

Traditional research has focused on environmental risk factors such as viral infection or neurotoxins. Some researchers felt that heredity might also play a role in the disease. Research in that area proved fruitful when a candidate gene for some cases of Parkinson disease was mapped to chromosome 4, which produces a protein called alpha-synuclein a known constituent of Alzheimer disease plaques. This protein is also a factor in Alzheimer diseases.

Why is nutrition of special importance for those with Parkinson’s disease?

Nutrition won’t cure Parkinson’s disease, or slow its progression, so why is it important? The answer is that Parkinson’s disease impacts many aspects of health:

• It can slow the gastrointestinal tract, causing constipation, slowed stomach emptying, and swallowing problems
• It can lead to loss of the sense of smell, and of taste.
• Medications used to treat Parkinson’s disease can cause nausea and appetite loss.
• And, one of the most important medications, levodopa, must compete with protein for absorption from the small intestine.

People with Parkinson’s disease are at increased risk for malnutrition. With attention to diet you will:

• feel better
• ward off nutrition-related diseases
• prevent hospitalization

A stay in the hospital can be costly, traumatic, and painful, but for those with Parkinson’s disease, there are additional concerns. Some hospital staff members are unfamiliar with the special medications used with Parkinson’s disease. Timing of medications can be difficult for staff, who may already have complicated schedules in place. By following good nutrition practices, you’ll feel better, and are much more likely to stay healthy and avoid the hospital.

What is optimal nutrition for people with Parkinson’s disease?

There is no single answer. Parkinson’s disease affects each individual quite differently. Some factors that can change your dietary needs include:

• your age
• your gender
• whether you have any other diagnosed conditions such as elevated blood pressure, food allergies, diabetes, etc.
• medications used may have a wide range of side effects that can impact nutritional health. That includes medications for heart disease, blood pressure, and other conditions, as well as Parkinson’s disease medications; it also includes many over-the-counter medications.

We will therefore discuss some of the most common concerns, some of which can become serious enough over time to require hospitalization. These include:

1. Bone thinning. Studies have shown that people with Parkinson’s disease are at increased risk for bone thinning – both men and women alike. Other research has demonstrated that malnutrition, unplanned weight loss, and falls greatly increase the risk for bone fracture and other disabilities. As Parkinson’s disease advances, it can increase the likelihood of falls. For those with Parkinson’s disease, therefore, it’s especially important to eat meals that provide the bone-strengthening nutrients - particularly calcium, magnesium, and vitamins D and K. Also important is regular exposure to sunlight (which provides vitamin D, a bone-strengthening vitamin), and weight-bearing exercise, such as walking.
   Nutrients, sunlight, and weight-bearing exercise will help to keep the bones strong, preventing fractures and hospitalization.
2. Dehydration. Parkinson’s disease medications can raise the risk for dehydration. Many people with Parkinson’s disease don’t realize how important water is for health. Dehydration can lead to confusion, weakness, balance problems, respiratory failure, kidney failure, and death. In the United States, dehydration is responsible for about 1.8 million days of hospital care each year (about ten days per patient), and costs more than $1 billion annually.
3. Bowel impaction. Parkinson’s disease can slow the movement of the colon, causing constipation. This makes it extra important to get enough fiber in the daily menu. If not dealt with properly, constipation can lead to a mass of dry, hard feces, impossible to pass normally. This is called bowel impaction. People with bowel impaction may require hospitalization, sometimes even surgery.
4. Unplanned weight loss. People with Parkinson’s disease often lose weight without meaning to, due to nausea, loss of appetite, depression, and slowed movement. Unplanned weight loss together with malnutrition can lead to a weakened immune system, muscle wasting, loss of vital nutrients, and risk for other diseases. A loss of ten percent of the maximum lifetime adult weight is a predictor for illness and death. For example, if a man’s normal adult weight was 150 pounds, and he loses 15 pounds without meaning to, even if over a period of several years, he is at increased risk for illness and death. Therefore, it may be necessary to supplement the diet with healthy, nutritionally dense calories.
5. Medication side effects. Medications perform important roles in helping to manage Parkinson’s disease symptoms; however, in some people they can have unwanted side effects. Taking more than one medication increases the likelihood of these adverse effects, and it’s a good idea to watch carefully for any changes upon starting a new medications. Furthermore, many people with Parkinson’s disease use drugs for other conditions, such as high blood pressure, elevated cholesterol, etc. These medications may also have undesirable side effects or contribute to additive side effects. Some common side effects of Parkinson’s disease medications include:
• nausea appetite loss, often followed by weight loss edema (fluid retention in the tissues)
• compulsive eating
• weight gain
6. Protein-levodopa interaction. One of the most important medications used to treat Parkinson’s disease is levodopa (Sinemet, Sinemet CR, Madopar, Dopar, Larodopa, Prolopa, Syndopa). However, levodopa must compete for absorption from the small intestine with proteins in food, and it may be necessary to take care with the timing of meals and medication.

Parkinson’s disease is a complicated disease, that affects each person differently. Still, there are many similar needs, such as the need for dietary fiber, fluids, and nutrients, that are common to most people with Parkinson’s disease.

Your general nutrition needs

The Food Guide Pyramid can be adapted for use as a general guide to nutrition for those with Parkinson’s disease. However, the pyramid does not distinguish among whole-grains vs. refined grains, or plant proteins and animal proteins, and these are important differences for those with Parkinson’s disease. Studies have found that a high-fiber diet with plenty of plant foods can enhance the absorption of levodopa, alleviate constipation, and provide the nutrients most needed in Parkinson’s disease. So we must adapt the Food Guide Pyramid to obtain the best food choices to combat Parkinson’s disease.

A daily menu based on whole grains, with plenty of vegetables and fruits, calcium-rich foods, and smaller portions of high-protein foods is the best possible choice for people with Parkinson’s disease. The whole grains contain the fiber that helps control the constipation that often occurs in Parkinson’s disease, as well as aiding in the management of blood sugar, blood pressure, cholesterol, and heart disease.

Vegetables and fruits provide the antioxidants, phytochemicals, minerals, and vitamins that nourish and support the muscles, nervous system, and organs of the body. Calcium is particularly important, as it helps keep the bones strong, preventing fractures. And protein keeps the muscular system healthy; strong, toned muscles help to maintain balance and strength.

Vitamin B6 and Parkinson’s disease

Before the combinations of levodopa/carbidopa and levodopa/benserazide were produced, people with Parkinson’s disease were prescribed levodopa alone. It was found that vitamin B6 prevented the absorption of the levodopa, so people were advised not to eat foods rich in B6, or to take B6 supplements.

Now, however, the medication commonly used combines carbidopa or benserazide with the levodopa. These “protect” the levodopa, so that vitamin B6 in reasonable amounts is no longer thought to be a problem. It’s generally recommended that vitamin supplements for people using carbidopa-levodopa or benserazide-levodopa contain no more than about ten-fifteen milligrams of B6 daily; some people can tolerate more than that, others may be more sensitive. If you are sensitive to B6, or if you need to take very large amounts (over 15 mg), take the B6 at least two hours apart from the levodopa.

You should inform your physician if you intend to use such large supplements of B6. Food sources of B6 include chicken, fish, pork, eggs, brown rice, soybeans, oats, whole wheat, peanuts, and walnuts, also fortified products such as cereals.

Levodopa and Food

A combination of levodopa with carbidopa or benserazide, known as the brand name Sinemet, Madopar, and other names, is an important medication used in treating Parkinson’s disease. However, there are some barriers to absorption of regular (quick-release) Sinemet/Madopar by the body.

1. If you take your Sinemet with a meal, or just after a meal, it may take a very long time for the Sinemet to be absorbed. This is because the stomach takes about one to three hours to empty food. If Sinemet is mixed with food, it takes the same amount of time to clear the stomach as the food does.
2. A high-fat meal takes even longer to clear the stomach. Fat is digested very slowly compared to carbohydrate and protein. If Sinemet is taken with a high-fat meal, it is further delayed in clearing the stomach.
3. Protein in the meal is broken down in the intestine into amino acids. These aminos must travel across the intestinal wall to get into the blood. Then they must cross the blood-brain barrier to enter the brain. Sinemet also must transit the intestine and the blood-brain barrier using exactly the same carrier system as the amino acids.

Protein and Levodopa

Most meals contain a large amount of protein, and the amino acids use up all the “carriers.” The Sinemet must wait until the carriers are free again, in order to cross over into the bloodstream. The same thing happens when Sinemet tries to get to the brain, where it does its work. Once more, amino acids clog all the “carriers” and Sinemet can’t get through to the brain.

Therefore, it’s best to take Sinemet 30 to 60 minutes before eating a meal. This allows the Sinemet to be quickly absorbed before the food can interfere. PROBLEM: Many people experience nausea when they first begin to use Sinemet. This usually disappears after a few weeks, although some people continue to feel nausea as long as they use Sinemet. SOLUTION: Take the Sinemet along with some foods that don’t contain protein. Ginger tea is a good choice for many people, because it often “settles the stomach.” A graham cracker or soda cracker along with the ginger tea may help, too — these are very low in protein, and should not interfere with the absorption of Sinemet. You can find ginger tea in health food stores.

Ginger ale may also be helpful for some people.

With the help of a registered dietitian, determine your protein needs and how and when it should be consumed. Plant protein is a good choice for part of your protein needs. Plant protein (dried beans, nuts, and seeds) contains a high ratio of carbohydrates to protein, whereas meat, fish, and poultry contain no carbohydrate.

It’s a good idea to eat several servings of cooked dried beans, peas, or lentils each week. Legumes have more fiber than any other food. Fiber helps with constipation and is heart-protective as well. Good choices are bean soup, refried beans, three-bean salad, and patties made from soy protein, like Morningstar Farms “Better’n Burgers” or Boca Burgers. You can find these and others in the freezer case at the grocery stores.

CoQ10 May Slow Parkinson's Disease

Building on the discovery that patients with Parkinson's have reduced levels of coenzyme Q10 (CoQ10) in their mitochondria, researchers at the University of California, San Diego, have found that supplementation with CoQ10 can slow the deterioration of function experienced by Parkinson's sufferers.

Researchers led by Clifford Shults, MD, divided 80 patients with early-stage Parkinson's into four groups. All of the patients had the tremor, stiffness and slowed movements typical of early-stage Parkinson's. Three of the groups received CoQ10 in dosages of 300, 600, or 1200 mg/day, together withvitamin E. The fourth group received placebo. Patients were evaluated every four months for 16 months, unless their level of disability made it appropriate to intervene with drugs.

Progression of symptoms was slower in the three treatment groups than in those taking placebo, and benefits were strongest in the group receiving 1200 mg/day (44% less reduction in cognition, motor function, and daily activities). CoQ10 was safe and well-tolerated at all three dosage levels. As expected, those taking CoQ10 showed significant increases both in serum levels of CoQ10 and in mitochondrial energy production.

The research was published in the October 15 issue of the Archives of Neurology (59, 10:1541-50, 2002).

Related sites:

National Parkinson Foundation

Medline Plus: Parkinson's Disease

American Parkinson's Disease Association

Nutrition developed using the best of science and nature combined!

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These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.