Parkinson’s Disease And Weight Loss

Should I Take Supplements

In general, its best to get vitamins and minerals from the food you eat rather than through supplements. And while there is some research that shows that supplemental Vitamin D and calcium may be beneficial in promoting bone health if bone thinning is an issue for you, theres much debate about that as well. The truth is, no supplements have been proven beneficial to Parkinsons. Again, its important to talk to your doctor about any supplements you think might be beneficial to introduce into your diet as there have been some cases where unregulated supplements have made Parkinsons symptoms worse.

Ive Heard A Lot About The Benefits Of Drinking Coffee Lately Is It Really Beneficial For People With Parkinsons

It is not clear whether there are any benefits to drinking coffee for people with Parkinsons. The consensus from the Parkinsons Foundation is that drinking coffee has no measurable benefits on the symptoms of Parkinsons, but neither should it worsen symptoms in most cases. The majority of the recent research that has come out about coffee has to do with its ability to reduce the risk of developing diseases such as Parkinsons and Alzheimers. Once you have already developed Parkinsons, its benefits are debatable.

So, provided it doesnt irritate your stomach, coffee is okay to drink, but you should talk to your doctor about any symptoms associated with drinking caffeine . Coffee can help if you suffer from daytime sleepiness, but consider having your last cup before the afternoon as caffeine late in the day can interfere with your sleep cycle if youre especially sensitive to it.

Description Of Weight Change In Patients With Pd Those With Atypical Parkinsonism And Controls

Baseline characteristics and comparisons between individuals with and without sustained clinically significant weight loss are presented in . On average, atypical parkinsonian patients were older than those with PD, and there were more men. At diagnosis, patients with PD and atypical parkinsonian patients were significantly lighter than controls by 5.6 and 7.1 kg, respectively, after adjustment for age and sex . After diagnosis, weight reduced in all study groups . Mean for the decrease in weight from baseline until the last follow-up visit was 3.2 , 4.1 , and 5.0 kg in controls, patients with PD, and those with atypical parkinsonism, respectively. These data were not obviously skewed . Patients lost weight more quickly than controls . Patients with PD lost weight more quickly than controls . Patients with atypical parkinsonism lost weight more quickly than those with PD . Sustained clinically significant weight loss within the first year of diagnosis was more common in patients with atypical parkinsonism than in those with PD and controls .

Baseline characteristics of controls and parkinsonian patients with no weight loss, sustained weight loss within the first year of diagnosis, and sustained weight loss at any time throughout follow-up

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The 17 Most Commonly Asked Questions About Parkinsons Nutrition

One of the topics our community members consistently ask us about is nutrition. Its not an easy topic to address, though, because it has so many layers and theres no one size fits all nutritional plan. Still, leaving it at that is not enough. In the first post in this series, we addressed the most important fact to know about Parkinsons nutrition and in the final post, well address how to experiment with your nutrition while living with Parkinsons. In this post, we opened up our inbox and pulled together the 17 most common questions weve received in the past year about Parkinsons nutrition, and weve done our best to answer them.

We wish there were more definitive answers to these questions and that there was such thing as the one, proven nutritional plan that works for all people trying to live well with Parkinsons, but thats not the case. The best we can do for now, therefore, is share the research as it stands, suggest potential pathways for you to investigate with your care team and encourage you to find the optimal path for you, even if it takes some time and a fair bit of trial and error.

With that said, here we go

Lately Ive Been Having A Lot Of Trouble With Chewing And Swallowing It Makes It Really Difficult To Eat What Can I Do

This is a common problem many people with Parkinsons struggle with. One thing you can do is to work with your foods consistency and consider softer food, like applesauce or slow-cooked meats. It can also help to add moisture to foods with gravy or sauce so that your food is easier to swallow.

Another option is to partially blend your meal. You can do this by putting 75% of your meal in the blender and saving the rest to eat as solid food. Crock pots are also great for cooking meats or vegetables so that they are really tender and easy to swallow. If you have trouble swallowing liquids, you can thicken fluid with things like applesauce. You can also consider meeting with a speech-language therapist to find specific ways to improve your chewing and swallowing.

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Getting The Right Balance

A balanced daily diet will contain a wide variety of foods from the five food groups listed below. Ideally you should eat food from at least three different groups at each meal, making sure that you cover all groups throughout the day. This may not be possible if you take certain medications so always follow any instructions you are given regarding medication and diet.

General dietary recommendations currently include:

• maintaining energy intake at 25-30 kilocalories per kilogram of body weight, with additional calories if you experience dyskinesia
• a carbohydrate to protein proportion of at least 4-5:1
• a recommended daily protein allowance of 0.8g/kg of body weight.

What Are The Primary Motor Symptoms Of Parkinsons Disease

There are four primary motor symptoms of Parkinsons disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinsons.

It is important to know that not all of these symptoms must be present for a diagnosis of Parkinsons disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinsons disease has a tremor, nor is a tremor proof of Parkinsons. If you suspect Parkinsons, see a neurologist or movement disorders specialist.

Tremors

Rigidity

Bradykinesia

Postural Instability

Walking or Gait Difficulties

Dystonia

Vocal Symptoms

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Weight Loss And Parkinsons Disease

Dad used to tell us that he has two sets of clothes: a normal set and a set of skinny clothes that emerge when he gets sick.

Dad was diagnosed with ulcerative colitis in his 30s, and the illness caused him to lose a startling amount of weight. He was thin to begin with, but the disease found ways to take more away.

Ulcerative colitis became more manageable for my dad as time moved forward. He put on a healthy amount of weight and chose his food based on desire rather than necessity. With the help of my mom and his friends, he was able to nurse himself back to health.

But for the next 34 years, his two sets of clothing would hang in the corner of his bedroom closet because he never was certain when his health might change. Today, Parkinsons disease is back to challenge this strategy. And Dads skinny clothes are making an appearance.

Enteric Nervous System And Gastrointestinal Disorders

Gastrointestinal functions are regulated by the enteric nervous system, a neuronal network organized in two plexuses, myenteric and submucosal, which control gut motility and secretion .

In PD, the enteral nervous system is affected by alpha-synucleinopathy which may explain the high incidence of gastrointestinal disorders, beginning in pre-motor stages of the disease. The most frequent symptom is chronic constipation affecting up to 89% of PD patients . The primary cause for constipation is impaired peristalsis with slow colonic transit due to neurodegeneration of myenteric neurons, which may be modulated by dopamine . In some patients, constipation is secondary to abnormal coordination of the rectoanal reflex with paradoxical contraction of the puborectalis muscle, which leads to defecatory dysfunction . Loss of serotonergic neurons in raphe nucleus is thought to be involved in this clinical feature . Gastroparesis is characterized by slowed emptying of food into the small bowel leading to postprandial fullness, early satiety, nausea, vomiting, and bloating . Gastrointestinal disorders affect the quality of life and may limit food intake thus contributing to mal- and under-nutrition in PD .

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Forget Fava Beans For Parkinsons

Fava beans contain an amino acid known as levodopa. Levodopa is an active ingredient in some Parkinsons medications. Seems like a good reason to eat a lot of fava beans, right?

Nope. Dr. Gostkowski explains that the amount in the beans is tiny compared to whats in your medication. You cant eat enough fava beans to have any effect on your symptoms, he says.

Bananas also have levodopa in them, Dr. Gostkowski says. But, like fava beans, its not possible to eat enough bananas to affect PD symptoms. Of course, if you like fava beans or bananas, enjoy! But dont go overboard or expect them to work like medication. Eat a variety of fruits, veggies, legumes and whole grains for balance.

Im Constipated All The Time Is There Anything I Can Do

Constipation is the most common gastrointestinal problem for people with Parkinsons. Increasing the amount of water you drink and your fiber intake are two things you can do to try and improve symptoms of constipation. Most experts recommend at least six to eight glasses of fluid a day, and some recommend prune juice as an excellent way to increase fluid intake and relieve constipation. Increasing the number of high fiber fruits like apples, prunes, dates, figs, radishes, berries, nuts and beans and insoluble fiber from whole grains like brown rice and rye can also help relieve your constipation. Remember that introducing additional fiber should be done slowly to allow for your digestive system to adjust to the effects.

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Aspet: Evaluation And Management

Table 2. Nutritional assessment measures available at present.

Given that the continuous progress of weight loss and undernutrition, it is of crucial importance to evaluate body weight and nutritional status for every PD patients routinely at the time of diagnosis and follow-up stage in order to ensure early detection and improved outcomes . Clinicians should acquire a comprehensive body weight and nutritional information at the time of diagnosis. BMI and nutritional assessment tools can offer an overview of weight and nutritional status of newly diagnosed PD patients. As weight loss progresses with disease stages, it is necessary to monitor weight and nutritional status routinely. Weighting monthly was advanced by some researchers during the follow-up stage. Moreover, it is necessary to use nutrition assessment tools such as MNA to monitor nutritional status every 6 months throughout the follow-up stage.

Figure 2. Nutritional assessment and management in patients with Parkinson’s disease. BMI, body mass index MNA, Mini-Nutritional Assessment PEG, percutaneous endoscopic gastrostomy.

Weight Changes In Pre

In prospective American cohort or casecontrol and Chinese epidemiological studies, a decrease of body weight was reported several years prior to diagnosis .1). On the other hand, large Finnish and Japanese cohort studies reported a weight gain in pre-diagnostic PD . The same result was found in the Honolulu Heart Program which included Americans of Japanese origin . No association between PD and BMI before or at disease onset was reported for the Greece EPIC population , the UK-based general Practice Research Database , and in Italian casecontrol studies . As degeneration of the dopaminergic system begins years before diagnosis , BMI variation may reflect a dysregulation of dopaminergic control of eating behavior rather than modification of energy metabolism in pre-motor stages of the disease. Apathy, depression, and anxiety are frequent in de novo PD and eating disorders may also appear in response to these negative emotional state. In the general population, a strong association between depression and overweight has been described which may be due to sub-threshold eating disorders described as emotional eating , increased snacking , or increased sweet preference . Alterations of eating behavior have been described in de novo PD, prior to treatment .

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Managing Symptoms With Nutrition

Constipation

• Eat foods high in fibre, such as wholegrain breads or bran cereals, fruits and vegetables, also legumes such as beans, peas and lentils.
• Increase your fluids to make sure your fibre intake works well.
• Try to be physically active each day.

Poor appetite, nausea and vomiting

• Have small frequent meals.
• Take medications with a small meal or snack .
• Drink some ginger ale it may help to reduce nausea.

Heartburn, reflux and bloating

• Limit or avoid alcohol, caffeine and carbonated drinks.
• Sit upright at meals and for 45-60 minutes after eating.
• Limit or avoid foods that may trigger symptoms such as spices, peppermint, chocolate, citrus juices, onions, garlic and tomatoes.
• Avoid using straws and sucking on hard candy to reduce gas and bloating.

Problems swallowing food or thin fluids

• See your doctor if you have problems swallowing foods or liquids. You may need a swallowing assessment.
• Ask your doctor to refer you to a dietitian. The dietitian can suggest some ways to modify the foods you eat and the fluids you drink so that they are right for you.

Problems moving jaw, lips, tongue

• Eat soft foods, like cooked cereals, soft scrambled eggs, gravies, sauces, thick soups, ground meats or soft casseroles.
• Try mincing your foods.

• Allow enough time to eat.
• Have small portions and pre-cut foods or finger foods.
• Eat in a quiet setting.

Orthostatic hypotension

• Reduce carbohydrate intake, especially single sugars.
• Increase intake of salt.

How Does Fibre Help

Fibre absorbs fluid as it moves through your bowel, forming a soft stool that can be passed more easily.

It is very important to increase your fluid intake if you increase the fibre in your diet, because too much fibre without enough fluid can increase constipation.

A dietitian can give you more information and advice.

How can I increase my fibre intake?

Fibre is found in cereals, seeds, nuts, fruit, vegetables and pulses, such as peas, beans and lentils. To increase your fibre intake you can try:

• eating high-fibre varieties of foods, such as wholemeal bread, pasta or brown rice
• altering recipes to use some wholemeal flour instead of all white flour
• choosing a breakfast cereal containing wheat, wheatbran or oats, such as Weetabix, porridge or bran flakes
• eating more vegetables. They can be raw or cooked, fresh or frozen. Try using more peas, beans or lentils
• eating more fruit. It can be fresh, stewed, tinned or dried. Try bananas, oranges or prunes
• gradually introducing ground linseeds. You can add 1 teaspoon to cereals, salads or yoghurts to start with and increase this over time to 1 tablespoon. If you do this, make sure you drink an extra glass of fluid a day, otherwise it wont work and may make constipation worse

When increasing your intake of fibre, it is important to do so gradually to avoid bloating or flatulence . Aim to introduce 1 new high-fibre food every 3 days.

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Weight Loss In Parkinsons Disease: The Relationship With Motor Symptoms And Disease Progression

1Parkinsons Disease and Movement Disorders Unit, Hospital de Clinicas, University of Buenos Aires, Argentina

Abstract

Objectives. To determine the prevalence of weight loss in PD patients, its relationship to the severity of motor manifestations and appetite changes. Methods. 144 PD patients and 120 controls were evaluated in a single session. All subjects were asked about changes in body weight and appetite. PD patients were examined with the UPDRS-III and the Hoehn and Yahr scales. Subscores of tremor, bradykinesia /rigidity, and non-dopaminergic symptoms were analyzed individually. Multivariable logistic regression analysis was used to determine an association between WL and PD motor manifestations. Results. 48.6 % of PD patients presented WL compared to 20.8 % of controls . Weight losers were significantly older and had longer disease duration, higher scores in HY stages, UPDRS-III, and NDS-subscore. Multivariable logistic regression analysis demonstrated that WL was associated with NDS-subscore and older age . Appetite in PD cases losing weight was unchanged , decreased , or even increased . Our results showed that WL occurs in almost half of PD patients and it is largely the consequence of disease progression rather than involuntary movements or a decrease in food intake.

1. Introduction

2. Methods

2.1. Subjects

2.2. Assessments

2.3. Statistical Analysis

3. Results

3.1. Participants

Among the 120 controls mean age was 62.6 ±10.9 years old .

Appetite/ food intake

Parkinsons And Weight Gain

Parkinsons medication does not tend to make people gain weight, but a small number of people may experience impulsive and compulsive behaviour. This is a side effect of some Parkinsons medication, particularly dopamine agonists and, in some cases, levodopa.

Impulsive behaviour is when a person cant resist the temptation to carry out certain activities. These are often activities that give an immediate reward or pleasure, such as gambling, hypersexuality and overeating.

So, someone may eat large amounts of food in a short period of time because they cant control their appetite, and as a result, they gain weight.

If you think youre experiencing this behaviour, speak to your GP, specialist or Parkinsons nurse.

We dont advise anyone to stop taking or to change their Parkinsons medication without the advice of their specialist or Parkinsons nurse.

Any changes have to be made slowly and gradually, and should always be carried out and reviewed by a specialist, because of the risk of side effects and withdrawal symptoms.

Someone experiencing impulsive or compulsive behaviour may not realise they have a problem. So it’s important that their carer is aware of these side effects.

Deep brain stimulation and weight gain

Some people with Parkinsons may put on weight quickly after having deep brain stimulation, a surgery sometimes used to treat the condition.

If you think youre experiencing this behaviour, speak to your GP, specialist or Parkinsons nurse.

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