BALANCED DIET, THE SECOND WAY TO BEAT PD

Through the words of the Holy Bible, the Greatest Book ever written in the world, you will find the answer to your greatest need, the miracle of healing in THE SECOND WAY to beat Parkinson's disease.

"Summer Sweets"
From an original painted with the foot by S. Subadri

EAT A BALANCED DIET

 "Please test your servants for 10 days. Give us vegetables to eat and water to dringk. Then see how we look in comparison with the other young men who eat from the royal table, and treat your servants according to what you see." He acceded to this request, and tested them for ten days; after ten days they looked healthier and better fed than any of the young men who are from the royal table. So the steward continued to take away the food and wine they were to receive, and gave them vegetables.

  

                                                                                                         DANIEL 1: 12-16    

Is there a diet recommended for Parkinson’s disease?

Good nutrition is important for everyone and has a significant role in the management of Parkinson’s disease (PD). In general, a healthy diet can increase energy, optimize the effect of medications, and promote overall well-being, especially in a patient with PD.

Patients with PD may experience constipation, delayed stomach emptying,drug-nutrient interactions, and weight loss. Parkinson's disease affects the autonomic nervous system, resulting in slowed movement of the GI tract. An individual may experience constipation and/or delayed gastric emptying. Gastric emptying may delay or decrease effectiveness of medications. With adequate intake of fluids and fiber, constipation may be prevented. Signs and symptoms of delayed gastric emptying should be observed when determining the timing of meals and medications.

Some individuals, particularly those who experience fluctuations of PD symptoms with their medications, may be very sensitive to the amount of protein in their diets. For these individuals, the timing of medications and meals/snacks containing protein becomes important. With the right amount of  protein consumed at the proper intervals throughout the day, that is 30-60 minutes after medications, both optimal absorption of medications and protein needs are met.

Parkinson’s disease symptoms such as tremor and the medication side-effect of dyskinesia may increase one’s caloric needs. When caloric needs are not met, the individual may experience unintentional weight loss and even malnutrition in instances of continuous low calorie intake. Adequate intake of vitamins and minerals is also important for many bodily functions. Each individual’s diet varies greatly, so you should first consult your doctor or dietitian before taking any supplements.

Eating a well-balanced, nutritious diet will greatly benefit a patient with Parkinson's disease so he can have more energy and his medications will work properly.

There are seven basic tips of having a proper diet in Parkinson's disease, namely:

1. Eat a variety of foods from each food category (carbohydrates, protein, fat) based on the food pyramid. It is recommended that 55 to 60 percent of the calories in your diet come from carbohydrates but moderate your intake of sugars. Fat intake should be no more than 30 percent of your total calories and should be low in saturated fat and cholesterol.

2. Include high-fiber foods such as vegetables, cooked dried peas and beans (legumes), whole-grain foods, bran, cereals, pasta, rice, and fresh fruit in your diet. Dietary fiber prevents constipation by adding bulk and softness to stools. To ensure adequate fiber intake, try to eat at least five servings of fruits and vegetables each day, and choose whole grains over refined foods.

3. Ask your doctor if there is a need for a daily vitamin supplement. Both Vitamin C and E are easily consumed in the diet in the recommended amounts per day so supplementation in mega doses is not warranted. Depending on your individual diet, a multi-vitamin formulation or supplement may be beneficial.

4. Ask your doctor about the need for mineral supplements. People with Parkinson’s disease have an increased risk of bone loss and should be sure their diet isn’t deficient in calcium. If you find it hard to get enough calcium in your diet, you may want to consider a supplement. Calcium carbonate is the most commonly used supplement but it reduces stomach acid, which can interfere with nutrient absorption and can also cause constipation for some people. Calcium citrate is a better choice because it doesn’t affect stomach acidity and isn’t constipating. Iron supplements can interfere with Levodopa absorption, so they should be taken separately but the small amount of iron in a standard multivitamin preparation won't be a problem.

5. Limit your salt intake and drink eight or more glasses of liquid each day. However, those PD patients with concommittant heart problems may need to limit their fluids so it is better to seek advice from your doctor.

6. Ask your doctor about your ideal body weight and how many calories you should consume each day. Weigh yourself once or twice a week, unless your doctor recommends weighing yourself more often. If you are taking diuretics or steroids, such as prednisone, you should weigh yourself daily.If you have an unexplained weight gain or loss (2 pounds in one day or 5 pounds in one week), contact your doctor. He or she may want to modify your food or fluid intake to help manage your condition.

7. Avoid drinking alcoholic beverages since alcohol may interfere with some of your medications. Limit caffeine (contained in coffee, tea, cola, and chocolate) because it may also interfere with some of your medications and may actually make you more dehydrated.

REFERENCES:
1.http://blog.michaeljfox.org/2012/03/ask-the-md-is-there-a-diet-recommended-for-parkinsons-disease/

2. http://www.webmd.com/parkinsons-disease/guide/eating-right

3. Jenny E. Loew, MS, RD, CSN, LDN and Carol Pratt , LDN. Good Nutrition and Parkinson's Disease (American Parkinson Disease Association, Inc)Copyright 2005 Revised 2007

HEALING OF PARKINSON'S DISEASE THRU GOOD NUTRITION

How Can A Vegetarian Diet Be Of Help To PD Patients


By Nona Lema


(Last of a 3-part article series)

The amount of  protein that the PD patient takes can have a major impact on the symptoms of the disease.  So experts say  ‘go high-carb, low-protein’ . They say PD patients who are taking levodopa need to limit the amount of proteins they eat.  Protein is made up of amino acids, and the amino acids in food interfere with levodopa getting into the brain. (Levodopa is also an amino acid). What better way to lessen protein intake than to adapt a vegetarian diet.  For a clear understanding of just how much protein an average person needs, I’m quoting here the whole of Chapter 2 of GULAY cookbook, wherein I discussed in detail about protein.

…Chapter 2    How Much Protein?

In my many years of teaching about the vegetarian diet, the most frequently asked question is, “where do you get your protein?”  Oftentimes, people are reluctant to eliminate meat from their diet because they are worried that if they do, they will somehow be protein deficient.  There is no need to be worried about protein deficiency.  This fear of ‘not getting enough protein’ from vegetable sources is not only unfounded but it actually leads to an even more serious problem.  It is how not to get too much!  Having too much protein in one’s body is actually as dangerous as not having enough.

In the world today, meat is generally thought to be the ideal source of protein.  Quality-wise, quantity-wise.  That is why nowadays whenever people say ‘protein’, it is usually associated with meat.  We were brought up thinking this way - - an idea widely propagated by major meat companies.

However,  we should be asking, is meat really the ONLY source of protein?  If we are supposed to have protein, how much is enough?  How much is too much? It is very important to know these things so that we don’t become too paranoid about so-called not getting enough.

Actually, the RDA (Recommended Dietary Allowance) of protein for an average adult is only between 40 to 65 grams daily.  Our daily needs of protein ranges from only TWO AND A HALF percent of our total daily calories up to about EIGHT percent.  So if we look at the percentage of calories from protein based on nutritive values of our local food, we will find  that if we eat, for example, an average serving of rice (16% protein) with Ginisang Mongo (29(%), our daily protein requirement is more than fully satisfied.  If we eat rice (16%) with Pritong Tokwa (43%) and some tomatoes (18%), our protein needs for the day is easily taken care of.  Even if we eat nothing but oatmeal (16%) or camote (8%) or saging na saba (8%) for the day, still we would have more than enough protein for our needs.  So here I’m showing you just how low our protein needs really are. And almost all plant food provide protein.

Once the daily requirement is met, the excess protein foes to waste.  Consuming more that what the body requires places a heavy burden on our whole system as it tries to rid the body of the excess. Meat is definitely high-protein food.  All flesh foods and eggs are considered so because they contain all the essential amino acids.  But in fact,  meat is so high in protein content that it is no longer necessary.  The body cannot absorb that much protein anyway.  For example,  an average serving of pork chop has about 180-200 grams of protein.  That’s far, far more than the daily requirement! Therefore,  if we are on a regular meat diet daily,  where does this huge amount of excess protein go?  It is broken down in the liver and excreted through the kidneys.  This causes the liver and the kidneys to work harder.  If the liver and the kidneys are overworked,  we eventually become ill.

So the point is: don’t worry.  First, we simply don’t need as much protein as we have been led to believe.  Second, whatever little amount we need, it is abundantly available in the vegetable kingdom in the form of legumes, beans, and many other vegetables.  Actually, vegetable protein is not only equal in quantity to meat protein, it is even superior in quality because none of the legumes, seeds, grains, or nuts contain cholesterol and saturated fats. Also,  they are nature-packed with vitamins, minerals, fiber and carbohydrates, whereas all flesh foods and eggs are packed with cholesterol and saturated fats.  So, we simply have to learn how to combine and balance different vegetable protein foods.  By mixing grains, legumes, nuts, and seeds in a meal, it is easy to get an adequate supply of protein containing all eight essential amino acids.

So, to summarize: Protein is an essential nutrient. We cannot just eliminate protein from the PD patients’ diet just because it interferes with levodopa.  So what do you do? The solution is to avoid high protein food such as meat and eggs AND make sure the PD patients eat enough protein from vegetable sources.

Grab the chance to meet the author, Ms. Nona Lema, in person, during the First Annual Convention of Pinoy Parkinson's Disease or Pinoy PD on October 22, 2011 in Makati City.

P.S. FINAL EXTENSION OF FREE REGISTRATION! Register for FREE on or before OCTOBER 15, 2011.

P.P.S. Register for a GUARANTEED SEAT and SLOT in the workshop to a LIMITED NUMBER of participants on or before o

P.P.P.S. Submit REGISTRATION DETAILS (Name, Age, Contact number and E-mail address) on or before September 30, 2011 to avail of FREE REGISTRATION and send via email to drajoy31@yahoo.com / drajoy31@gmail.com

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HEALING OF PARKINSON'S DISEASE THRU GOOD NUTRITION

(Second of a 3-part article series)


Nutrients Found In Plant Food
By Nona Lema
   

Nutrients refer to all things that make up how healthy food is - - like vitamins, minerals, carbohydrates, protein and fats.  My advice to everyone in general is, always incorporate a variety of fruits and vegetables in your meals.  This is the best way to ensure that you are getting enough of many nutrients.

Sometimes, it can be mind-boggling the way daily nutritional requirements are written.  If you’re like me, who go crazy with all the nutritional statistics and figures, then the best thing to remember is this:  have a ‘balanced’ amount of all the different types of natural food available in nature - -that’s all.  Make sure to eat a daily serving from each food group such as whole grains, fruits, vegetables, nuts and legumes.  Very simple formula.  You can never go wrong that way.

Now, speaking of nutrients for PD patients, experts say  focus on calcium and vitamin D (for maintaining bone health) and antioxidants (for helping reduce the loss of dopamine-producing neurons).

In other words,  feed them all things naturally healthy but most specially foods that are rich in  calcium and antioxidants.

Good sources of calcium are:  dairy, green leafy vegetables, almonds, pistaccio, molasses, wheat, brewer’s yeast, broccoli, cabbage, okra, carob, oats, sesame seeds, turnips and tofu.

Good sources of antioxidants are:  nuts, dark-colored fruits, leafy green vegetables, tomatoes, broccoli, red kidney beans, pinto beans.

Experts say an average adult need 1000-1500 mg of calcium and roughly the same amount of antioxidants a day.

To translate, for breakfast serve the PD patient an average serving of hot or warm milk, or fruit milk shake or fruit smoothie such as banana, avocado, papaya, melon, etc.  One important thing you should remember about milk is that it is best to be boiled first in order to predigest it so it is easily absorbable. So in milkshakes/smoothie, boil the milk first, let it cool before blending with the fruits.
The worst thing to take is cold milk, as in the form of iced milk shakes or drinks.  These are actually modern Western concoctions that have no bearing in eastern nutritional and medicinal food. Cold milk is not only hard to digest, it is also mucus-forming. Milk  drinks should always be taken hot or warm.

In oatmeal or cereals, boil the milk first before adding the oats or cereals. For sweetener try switching to molasses.

For variety you can also serve grilled cheese or just plain cheese sandwich; or pasta with cheese or yoghurt and fruits - -always have a lot of fruits.  Interchangeably,  serve fried/plain rice with tofu or tokwa and different kinds of gulay dish.

For lunch and dinner:  As a rule, have a variety of talbos/dahon every mealtime - - talbos ng kamote, sili, ampalaya, kalabasa, sayote, sitaw; dahon ng malunggay, kangkong, alugbati, talinum, spinach, etc. Serve them as native vegetable salad or sabaw (soup).  In your regular ginisang gulay or ginataang gulay, grain/pasta or noodle dish, always incorporate some form of leafy vegetable.  And then for added flavor, nutrients and texture, add tofu or tokwa.

Tofu or tokwa  is the best meatless substitute.  It can be mixed in sauces, pasta, chilis, stirfries, etc because it is so close in texture to meat and a rich source of nearly all nutrients that your PD patient needs.

For PD patients the best way to have nuts or seeds is to have a  sprinkling of  it. 

In my family, one favorite regular table item is ‘sesame salt’ or ‘peanut salt’.  To prepare this,  roast one cup of sesame seeds or fry one cup of peanuts.  Blend in a blender with a little salt.  Put in a shaker or small bottle container.  Sprinkle on your rice and pass around during mealtime. My children just love it.  An appetizing and nutritious way to have your daily dose of calcium and antioxidant without your even knowing it!

And then for dessert you can have blueberries.  Blueberries are a little bit expensive but once in a while have them in muffins or pies or tarts. Again, a delicious way of ensuring that your PD patient gets their needed nutrients. Of course our wide variety of local fruits may also be prepared in so many delicious dessert dishes.  So as I have said before, try to be creative about it.

And lastly, In one vegetarian cookbook written by Jeanne Lemlin, she mentioned some tips  about the ‘secret to a relaxed cooking’.  I’d like to share them with you.  She says: “have all the ingredients you will need gathered together in front of you.  Have all the dishes or pans taken out. Have all the precooking done ahead of time, for example, peeling and chopping of vegetables, measuring, etc.” To which I’d like to add: take a deep breath and pause for a minute of  relaxation.

How Can A Vegetarian Diet Be Of Help To PD Patients? (Part 1)

By Nona Lema


(First of a 3-part article series)


Introduction

Hi! I’m Nona Lema. I’m not a doctor nor a nutritionist. At home, I’m simply a wife and a mother who loves to cook delicious and healthy vegetarian meals for my family - - traditional Filipino food that we, as a family, have enjoyed eating together for the past 30 years.

In the following article series, I’d like to show you, in simple language, the direct link between PD and the vegetarian diet. Anyone who is interested in cooking healthy food for their PD patient will see and understand the connection very clearly. Veggie food and PD are compatible on these basic points: a) fiber, b)nutrients, AND c) protein.

Of course there have been many medical and nutritional researches/statistics made to prove that a vegetarian diet is indeed excellent for PD patients. But the question is, how do you translate these informations into a delicious meal? In other words, when you go to the kitchen to cook lunch or dinner for your loved one with PD, what do you cook? And why?

This article series is meant to educate, to share, most of all to show love and compassion to those afflicted with PD - - by showing how you can prepare nice, home-cooked meals that they too can enjoy. Happy veggie cooking!

Fiber Rich Food

It is very important that caregivers of PD patients understand very well the need for more fiber intake. What has fiber got to do with PD? PD is a progressive neurological disorder that results in the death of dopamine-producing cells in the brain. Loss of dopamine affects movements. So because PD patients are generally “slow mo”, therefore they also generally suffer from chronic constipation. Fiber is beneficial in preventing constipation.

Now, this is another important thing caregivers should understand - - Fiber is found ONLY in plant food. Foods containing fiber include fruits, vegetables, nuts and grains. Meat, fish, chicken and eggs do not contain fiber AT ALL.

We Filipinos are very fortunate to have been blessed with so much variety of different fruits and vegetables, our very own prutas at gulay, - - delicious, juicy, succulent, naturally healthy; pagkaing butil-- whole grains and nuts, beans and legumes that are so fragrantly wholesome, so full of rich, nutritious taste.

To be really healthy, experts say you need to consume about 25-40 gms of fiber everyday. For PD patients, a little more, maybe 50-60 gms.

To translate, it means for breakfast, maybe you can prepare for them one serving of oatmeal or cracked wheat or farina (also known as sooji), cooked with milk and sweetened with honey or muscovado sugar, a slice of buttered wheat bread toast or fried tofu sandwich. Be sure to always feed them with lots of fruits in season – bananas, pineapple, papaya, chico, etc, sliced up fresh or juiced . Root crops are also a very nutritious and fibrous breakfast item. You can serve them camote, gabi, kamoteng kahoy, ube - -cooked in many different traditional kakanin or ginataan style. Sometimes you can serve them plain or fried rice with scrambled tofu instead of bacon and scrambled eggs.

Tofu or tokwa is sometimes called the ‘vegetarian’s best friend’. It is a by-product of soy beans, sometimes called ‘the poor man’s protein’; it is such a versatile food and so protein-rich. It has been eaten for thousands of years in most Asian cultures that were traditionally vegetarian. Tofu or tokwa may be substituted to almost anything that you would need meat, fish, chicken and eggs for.

So for now, a good starting point in adapting a vegetarian or at least a ‘semi-veg’ diet is to try to eat meat less often. Substitute as often as you can with healthier, more fibrous food alternatives. All your all-time favorite meat, fish, chicken and egg dishes such as pork or chicken adobo, arroz caldo, escabeche, pork menudo, beef caldereta, etc.may be prepared the healthy meatless way. How? Simply substitute with tofu or tokwa. Or for a fancier version, try substituting with gluten, and/or different varieties of ‘veggie cold cuts’ - - veggie meat, veggie sausage/hotdog, veggie tapa (all available at popular vegetarian food stores).

Soups may be prepared from mashed or pureed or blended vegetables; or mixed with grain pasta or noodles. But then again, instead of meat, fish or chicken soup stock, try substituting with cream of vegetable powder or canned soup, vegetable bouillon or any kind of plant-based seasoning or appetizer.

For lunch and dinner, you can prepare all kinds of ginisang gulay, or ginataang gulay - -sitaw, kalabasa, talong, upo, okra, ampalaya, bichuelas, pechay, repolyo,etc. It’s also a good habit to always feed them kamatis, either cooked or fresh because it’s a fiber rich food. With your variety of gulay, simply make a gentle, healthful twist - -instead of sauteing with pieces of pork, shrimp, chicken or eggs, again try mixing slices of fried tofu or tokwa.

Why is there a need to gradually avoid (if possible) all kinds of meat food? Because, as I have said earlier, all meat food have ZERO fiber. It means meat food does not contain moisture and bulk. Meaning, therefore, that it does not make the stool soft and easy to dispose. On the contrary, it makes the stool become even more compacted and dry. That is why, if the PD patient’s diet is meat-heavy, they will have a tendency to suffer from chronic constipation.

So again, try to remember - -the only way to get good fiber is to eat vegetable food.

As far as cooking veggie food for your PD patient goes, be creative. Be innovative. Read up on a lot of vegetarian recipes. Familiarize yourself with the different ways of substituting your meat food with vegetable food.

One last piece of advice:

If there’s extra attention and care there in your cooking, the PD patient will feel it. If the cooking is done grudgingly, or with anger or contempt or just because it’s a routine paid job, then the PD patient will also feel it. So the least we can do for them is, try to cook delicious meals—and cook them with genuine care and concern.

Note:

Nona Lema is the author “GULAY”, the best selling Filipino Vegetarian Recipebook, available at National Bookstore and Powerbooks

GOOD NUTRITION IN PARKINSON'S DISEASE

Good nutrition is important for everyone and has a significant role in the management of Parkinson’s
disease (PD). In general, a healthy diet can increase energy, optimize the effect of medications, and
promote overall well-being, especially in a patient with PD.


Patients with PD may experience constipation, delayed stomach emptying,drug-nutrient interactions, and weight loss. Parkinson's disease affects the autonomic nervous system, resulting in slowed movement of the GI tract. An individual may experience constipation and/or delayed gastric emptying. Gastric emptying may delay or decrease effectiveness of medications. With adequate intake of fluids and fiber, constipation may be prevented. Signs and symptoms of delayed gastric emptying should be observed when determining the timing of meals and medications.


Some individuals, particularly those who experience fluctuations of PD symptoms with their
medications, may be very sensitive to the amount of protein in their diets. For these individuals, the
timing of medications and meals/snacks containing protein becomes important. With the right amount of  protein consumed at the proper intervals throughout the day, that is 30-60 minutes after medications, both optimal absorption of medications and protein needs are met.


Parkinson’s disease symptoms such as tremor and the medication side-effect of dyskinesia may increase one’s caloric needs. When caloric needs are not met, the individual may experience unintentional weight loss and even malnutrition in instances of continuous low calorie intake. Adequate intake of vitamins and minerals is also important for many bodily functions. Each individual’s diet varies greatly, so you should first consult your doctor or dietitian before taking any supplements.


Eating a well-balanced, nutritious diet will greatly benefit a patient with Parkinson's disease so he
can have more energy and his medications will work properly. There are ten basic tips of having a
proper diet, namely:
1. Eat a variety of foods from each food category based on the food pyramid (see below).
2. Ask your doctor if there is a need for a daily vitamin supplement.
3. Maintain your weight through a proper balance of exercise and food.
4. Ask your doctor about your ideal body weight and how many calories you should consume each day.
5. Include high-fiber foods such as vegetables, cooked dried peas and beans (legumes), whole-grain
foods, bran, cereals, pasta, rice, and fresh fruit in your diet.
6. Choose foods low in saturated fat and cholesterol.
7. Moderate your intake of sugars.
8. Limit your salt intake.
9. Drink eight 8 oz. glasses of water per day.
10. Ask your doctor about drinking alcoholic beverages since alcohol may interfere with some of your medications.

CARBOHYDRATES


Carbohydrates are starches and sugars which are the main energy source for the body. One gram of
carbohydrates provides 4 calories. These are found in fruits, breads and cereals, milk products, and
vegetables. These are also found in most desserts, candy, and sweetened foods.
The“good” carbohydrates are the complex carbohydrates which are found in foods that are less refined and closer to their natural state. Good sources include foods made with whole grains, brown rice, and fresh fruits and vegetables. These are usually good sources of vitamins, minerals, and fiber, too. These are broken down slowly in the digestive tract, and gradually enter the bloodstream.
Dietary carbohydrates play a role in the absorption of levodopa, the usual first line drug  used in
PD, by triggering a release of insulin which lowers the blood levels of large neutral amino acids
(LNAA's).  Lower levels of  LNAA's in the blood may enhance the delivery of levodopa to the brain . The recommended allowance for carbohyrates is 55 to 60 percent of the calories in your diet.


PROTEINS


Proteins are combinations of amino acids that build, repair, and maintain all of your body’s tissues.
Dietary proteins are broken down into amino acids in the stomach and intestine and then absorbed into the blood, where they become the “building blocks” for new proteins. Your body makes nonessential amino acids. The “essential” amino acids are not synthesized in the body so these are obtained through the diet. To get the necessary amino acids, it is important to eat a variety of foods, including good sources of protein in amounts to meet your needs. If you don’t consume enough carbohydrates and fats, tissue proteins can be broken down into amino acids and used by the body for energy instead of maintenance. When you consume more protein than you need, the protein is broken down and stored as body fat. Protein provides 4 calories per gram.
Good sources of protein include foods from animal and plant sources. Animal sources include meat,
poultry, fish, eggs, milk, and cheese. Plant sources include legumes (lentils, dry beans and peas),
seeds, nuts, breads, and cereals.


FATS


Fats are complex substances made up of combinations of fatty acids which supply energy in the form of calories. They are a concentrated source of energy, providing 9 calories per gram.  Fats have some
positive health benefits although they are best avoided or kept at a minimum in certain disease
conditions like hypertension, obesity and heart ailments.  These help to support the work of other
nutrients in your body. The fat-soluble vitamins A, D, E and K wouldn’t be effective without dietary
fats to dissolve them and provide transport in the bloodstream.


Linoleic acid and alpha-linolenic acid are fatty acids (the “building blocks” of fat) that are
considered essential because they are not synthesized in the body and have to be obtained from the
diet. Alpha-linolenic acid converts to omega-3 fatty acids, which help to keep your brain and nervous
system healthy. Linoleic acid is an omega-6 fatty acid. Both may promote heart health by lowering
total and LDL cholesterol.Both of these essential fatty acids are easily available to the body in a
varied diet. Fatty fish, soy, flaxseed, canola, nuts, and seeds are good sources of omega-3 fatty
acids. Soy, corn, and safflower oil are good sources of omega-6 fatty acids.


Fat intake should be no more than 30 percent of your total calories, with an emphasis on fewer
saturated fats. Fat takes longer to leave the stomach than carbohydrate or protein; therefore, it’s
best to avoid large, high-fat meals if you’re taking Sinemet because it can decrease the effectiveness
of the medication by delaying gastric emptying.


FIBER


Fiber is the indigestible part of a food of plant origin. It can’t be used by the body for energy, but
is still necessary for good health by helping to promote regular bowel movements. Dietary fiber can be soluble or insoluble. Both types of fiber have significant health benefits, but they work in different
ways.


Insoluble fiber helps to prevent constipation by adding bulk and softness to stools. Adequate fluid
intake is necessary, since insoluble fiber works by absorbing fluid. Good sources of insoluble fiber
are whole wheat products including wheat bran, vegetables, fruit, flaxseeds, and legumes.


Soluble fiber helps to lower blood cholesterol levels, and regulate blood sugars. Good sources of
soluble fiber are legumes, oats and oat bran, barley, flaxseeds, and many fruits and vegetables.


Constipation is a common problem in Parkinson’s disease. It can be caused by medications, decreased fluid intake, or the condition itself. The nerves controlling the gastrointestinal tract can be
affected by PD, causing increased intestinal content transit time. Dietary fiber is very important in
the management of constipation. To ensure adequate fiber intake, try to eat at least five servings of
fruits and vegetables each day, and choose whole grains over refined foods. In addition, try to drink
6 to 8 glasses of fluid each day, preferably noncaffeinated.


VITAMINS


Vitamins are organic compounds necessary for life, although they do not, independently, provide
energy. Vitamins are essential to many bodily functions, including growth, metabolism, blood clotting, preventing diseases, body growth and maintenance, immune function, and many more.


Vitamin D


Vitamin D promotes the absorption of two minerals - calcium and phosphorus - and regulates the calcium levels in the blood. It also helps in depositing these minerals in your bones and teeth, making them stronger. Fortified foods such as milk and specially fortified orange juice are common sources of Vitamin D. Milk products such as cheese and ice cream are generally not fortified with Vitamin D.
Sunshine is a significant source of Vitamin D because your body makes Vitamin D from UV light touching your skin.


The RDA for adults is 400 IU per day, and 600 IU by the age of 70. The increased amount for older
adults is due to the fact that as we age, our skin isn’t able to produce as much Vitamin D. If you do
not go outdoors, you cover up, or use a sunscreen, you need to pay special attention to getting
Vitamin D from fortified foods or consider taking a supplement. One cup of Vitamin D fortified milk
contains 100 IU.


Vitamin C & E


Vitamin C, or ascorbic acid, and Vitamin E have antioxidant properties and were once speculated to be protective against the progression of PD. Theoretically, free radicals are produced by metabolic
processes in the brain and they can damage nerve cells, including dopaminogenic cells. Antioxidants
are known to break down free radicals or prevent their formation. Studies, however, do not show any
significant benefit of consuming more than the recommended dietary allowance (RDA) for Vitamin C and E for people with PD.


Vitamin C is important for wound healing, absorption of iron, increasing resistance to infection, and
the synthesis of neurotransmitters. Good sources of Vitamin C are citrus fruits, broccoli, brussel
sprouts, green peppers, strawberries, cauliflower, cabbage, tomato, cantaloupe, and spinach. The RDA for Vitamin C for an adult is 60mg per day. This is equal to approximately 1/2 cup of orange juice or 1 cup of cantaloupe.


Along with its powerful antioxidant capabilities, Vitamin E is also important in energy and cell
metabolism. The RDA for Vitamin E for adult males is 10mg and 8mg for females. This is equal to
approximately 1.5 oz. almonds or 3 tablespoons of corn oil. Other good sources of Vitamin E are
vegetable oils, wheat germ, spinach, collards, nuts, and dried beans.


Both Vitamin C and E are easily consumed in the diet in the recommended amounts per day; therefore, supplementation in mega doses is not warranted. Depending on your individual diet, a multi-vitamin formulation or supplement may be beneficial. Please consult your doctor or dietitian for further information.


MINERALS


Minerals are inorganic substances essential to life. Theses help regulate the various body processes
such as circulation, respiration, digestion, and elimination. These are also found in water and in
natural foods but are used to fortify some processed foods.


Mineral toxicity is possible but unlikely if you are not taking megadoses of a mineral over a period
of time. Mineral deficiencies are also possible but not common if you are eating a wide variety of
foods from all five food groups.


CALCIUM


Calcium builds bones, and helps them to remain strong, by slowing the rate of bone loss as you age. It also assists in muscle contraction, promotes normal nerve function, and helps your blood clot if you’re bleeding. Milk and milk products such as yogurt and cheese are excellent sources of calcium. In addition, some dark green leafy vegetables (kale, broccoli, bok choy), canned salmon and sardines with bones, calcium-fortified soy milk and orange juice, and tofu made with calcium sulfate are good
sources.


The RDA for adults is 800 IU until age 50, when it is increased to 1200 IU. People with Parkinson’s
disease have an increased risk of bone loss, and should be sure their diet isn’t deficient in calcium.
If you find it hard to get enough calcium in your diet, you may want to consider a supplement. Calcium carbonate is the most commonly used supplement; however, it reduces stomach acid, which can interfere with nutrient absorption. It can also be constipating for some people. Calcium citrate is a better choice; it doesn’t affect stomach acidity, and it isn’t constipating.


Excellent sources of calcium:
(approximately 300mg per serving)
1 cup of low fat milk
1 cup of yogurt
1 1/2 ounce of hard cheese
1 1/4 cup cottage cheese
1 to 2 cups of cooked dark green, leafy vegetables
2 cups of cooked broccoli


IRON


Iron forms part of hemoglobin, the molecule that enables your red blood cells to transport oxygen
throughout the body. It also helps the immune and central nervous systems and aids in energy
production.


The body is very efficient at storing and reusing iron, and stored levels tend to increase with age;
however, iron deficiency can be a problem for younger women because of blood loss from menstruation and for older people because of a poor diet. A suspected deficiency should always be evaluated by your healthcare provider before taking supplements because excess iron can be harmful. The RDA for iron for adult women is 10 mg and 15 mg for adult men. Meat, poultry, and fish are excellent sources of iron. Fortified grain products, like cereals and breads, legumes (especially soybeans), nuts, and vegetables also provide iron in the diet. Foods that are high in Vitamin C, such as strawberries, broccoli, or citrus fruits, enhance iron absorption.


Iron supplements can interfere with Levodopa absorption, so they should be taken separately, although the small amount of iron in a standard multivitamin preparation shouldn’t be a problem.


COENZYME  Q10


Coenzyme Q10, or ubiquinone, or CoQ10 for short, is a naturally occurring compound produced in the heart, liver, kidneys, and pancreas. CoQ10 is used by the body for energy production and as a powerful antioxidant. The amount of CoQ10 produced by the body declines with age, heart disease, and with some medications i.e., statins, some diabetes drugs, and perhaps coumadin.
CoQ10 is present in food in small amounts, primarily in organ meat, chicken, beef, soy oil, sardines,
mackerel, and peanuts. Because CoQ10 is in food only in scarce amounts, it is commonly consumed as an oral supplement.


Oral CoQ10 supplementation has been used to treat heart failure because of its role in energy
production. It may also be beneficial in treating a number of other diseases as well as Parkinson’s
disease due to its antioxidant effects. A theory is that it protects cells from damage caused by PD.
Research suggests a positive trend for CoQ10 and the slowing of the progression of the disease with
little side effects. Recent studies have shown that a dose of 1,200 mg per day may have the most
benefit in PD patients; however, CoQ10 recommendations are premature at this time and further research is warranted. Please consult your doctor beforehand.


PARKINSON'S MEDICATIONS AND FOOD INTERACTIONS


The primary drug used in the treatment of Parkinson’s disease is Levodopa. There are several diet
components that interfere with the absorption and thus, ultimately, with the effectiveness of this
medication.


   PROTEIN AND LEVODOPA INTERACTION


Compounds called amino acids make up dietary protein. Levodopa is structurally similar to certain
amino acids (large neutral amino acids, or LNAAs), and they compete for the same transport system
across the blood-brain barrier. Levodopa must arrive at its destination in the brain to be converted
to dopamine, and this competition can decrease the amount of Levodopa reaching the brain. Some people with Parkinson’s disease are not affected by protein in the diet, but others notice a reduced
effectiveness of Levodopa when it is taken too close to meals. Also, some people find that the
proteins in milk and milk products block the Levodopa absorption to a greater extent than other
proteins.


     GASTRIC EMPTYING


Before it can reach the transport mechanism at the blood-brain barrier, Levodopa must reach the small intestine for absorption. Food in the stomach can slow the progress of the Levodopa by delaying the emptying of stomach contents into the small intestine. The longer Levodopa remains in the stomach, the more vulnerable it is to enzymes that prematurely convert it to dopamine, which is ineffective if not produced in the brain. Once in the small intestine, the Levodopa must compete with any LNAAs present for absorption into the bloodstream. Also, Levodopa has a very short plasma half-life, which means that it will start to disappear from the blood in 60 to 90 minutes. Therefore, it needs to reach the brain before this occurs.


Parkinson’s disease can affect the nerves of the GI tract causing delayed gastric emptying. If you
experience symptoms of bloating, delayed uptake of medications, quick fulfillment after eating,or
gastroesophageal reflux, consult your doctor or dietitian for helpful hints and/or medication changes.


     TIMING OF MEDICATION


Levodopa should be taken at least 30 minutes prior to meals, except in cases where the drug produces
nausea, or if there is an excess of dyskinesia after taking Levodopa. It generally works best when
taken on an empty stomach, about ½ hour before meals or at least one hour after meals. It should be
taken with 4-5 oz. of water so the drug will be absorbed in the body more quickly.
For some patients, levodopa may cause nausea when taken on an empty stomach. Your doctor may prescribe a combination of levodopa and carbidopa (called Sinemet) or carbidopa by itself (called Lodosyn). If nausea persists, your doctor may prescribe another drug to relieve these symptoms. There might also be a need to modify your daily protein intake. In rare cases, a diet high in protein limits the effectiveness of levodopa. For nausea, which is common during the early adjustment to Levodopa, it should be taken with a light, low-protein snack.


There are ways to contol nausea, namely:
1. Drink clear or ice-cold drinks. Drinks containing sugar may calm the stomach better than other
liquids.
2. Avoid orange and grapefruit juices because these are too acidic and may worsen nausea.
3. Drink beverages slowly.
4. Drink liquids between meals instead of during meals.
5. Eat light, bland foods (such as saltine crackers or plain bread).
6. Avoid fried, greasy, or sweet foods.
7. Eat slowly.
8. Eat smaller, more frequent meals throughout the day.
9. Do not mix hot and cold foods.
10. Eat foods that are cold or at room temperature to avoid getting nauseated from the smell of hot or
warm foods.
11. Rest after eating, keeping your head elevated. Activity may worsen nausea and may lead to
vomiting.
12. Avoid brushing your teeth after eating.
13. If you feel nauseated when you wake up in the morning, eat some crackers before getting out of bed
or eat a high protein snack before going to bed (lean meat or cheese).
14. Try to eat when you feel less nauseated.


Some Parkinson's disease medications may make you thirsty. Here are eight tips to help relieve thirst
or dry mouth:
1. Drink eight or more glasses of liquid each day. However, those PD patients with concommittant heart
problems may need to limit their fluids so it is better to seek advice from your doctor.
2. Limit caffeine (contained in coffee, tea, cola, and chocolate) because it may interfere with some
of your medications and may actually make you more dehydrated.
3. Dunk or moisten breads, toast, cookies, or crackers in milk, decaffeinated tea or coffee to soften
them.
4. Take a drink after each bite of food to moisten your mouth and to help you swallow.
5. Add sauces to foods to make them soft and moist. Try gravy, broth, sauce, or melted butter.
6. Eat sour candy or fruit ice to help increase saliva and moisten your mouth.
7. Don't use a commercial mouthwash. Commercial mouthwashes often contain alcohol that can dry your mouth. Ask your doctor or dentist about alternative mouthwash products.
8. Ask your doctor about artificial saliva products which may be available by prescription.


Sometimes, a PD patient may be too tired to eat later in the day or has poor appetite. Here are some
tips to help improve your appetite and make each meal enjoyable:
1. Choose foods that are easy to prepare and eat.
2. Ask your family/caregiver to help with meal preparations.
3. Keep healthy snack foods on hand such as fresh fruit and vegetables, pretzels, crackers, high-fiber
cold cereals.
4. Freeze extra portions of what you cook so you have a quick meal when you're too tired.
5. Rest before eating so you can enjoy your meal.
6. Try eating your main meal early in the day so you have enough energy to last you for the day.
7. Consult your doctor especially when you're showing signs of depression aside from poor appetite.
Your appetite will probably improve after depression is treated.
8. Avoid non-nutritious beverages.
9. Eat small, frequent meals and snacks.
10. Walk or participate in another light activity to stimulate your appetite.
11. Make eating a pleasurable experience by using colorful place settings and play background music
during meals.
12. Try not to eat alone. Invite a guest to share your meal or go out to dinner.
13. Use colorful garnishes such as parsley and red or yellow peppers to make food look more appealing
and appetizing


Here are some tips to help you eat more at meals and at snacks.
1. Drink beverages after a meal instead of before or during a meal so that you do not feel full before
you begin eating.
2. Plan meals to include your favorite foods.
3. Try eating the high-calorie foods in your meal first.
4. Use your imagination to increase the variety of food you're eating.
5. Don't waste your energy eating foods that provide little or no nutritional value such as potato
chips, candy bars, colas, and other snack foods.
6. Choose high-protein and high-calorie snacks. High calorie snacks include: ice cream, cookies,
pudding, cheese, granola bars, custard, sandwiches, nachos with cheese, eggs, crackers with peanut
butter, bagels with peanut butter or cream cheese, cereal with half and half, fruit or vegetables with
dips, yogurt with granola, popcorn with margarine and parmesan cheese, or bread sticks with cheese
sauce.


WEIGHT MAINTENANCE IN PARKINSON'S DISEASE


Malnutrition and weight maintenance is often an issue for people with Parkinson's disease. Here are
some tips to help you maintain a healthy weight:
1. Weigh yourself once or twice a week, unless your doctor recommends weighing yourself more often. If you are taking diuretics or steroids, such as prednisone, you should weigh yourself daily.
2. If you have an unexplained weight gain or loss (2 pounds in one day or 5 pounds in one week),
contact your doctor. He or she may want to modify your food or fluid intake to help manage your
condition.
3. Ask your doctor about nutritional supplements. Sometimes supplements in the form of snacks, drinks (such as Ensure or Boost), or vitamins may be prescribed to eat between meals to help you increase your calories and get the right amount of nutrients every day. But, be sure to check with your doctor before making any dietary changes or before adding supplements to your diet. Some can be harmful or interfere with your medication.
4. If you are underweight, avoid low-fat or low-calorie products. (unless other dietary guidelines
have been recommended). Use whole milk, whole milk cheese, and yogurt.



REFERENCES:


1. http://www.webmd.com/parkinsons-disease/guide/eating-right
 2. Jenny E. Loew, MS, RD, CSN, LDN and Carol Pratt , LDN. Good Nutrition and Parkinson's Disease (American Parkinson Disease Association, Inc)Copyright 2005 Revised 2007