Parkinson’s Disease: The Basics of Good Nutrition
You have been prescribed levodopa (L-dopa) to help control the symptoms of Parkinson’s disease. This drug does have some nutritional implications. ▪ Your health care professional may recommend that you limit your intake of protein at breakfast and lunch, and eat a sizeable amount at dinner, or recommend that you split your total daily intake of protein evenly throughout the day. Talk to your doctor or dietitian before proceeding with either plan. ▪ If you take a vitamin supplement that contains B , also known as pyridoxine, you may need to
stop taking it while on some forms of levodopa. Ask your doctor or dietitian if this is something that you need to be concerned about. Choose a supplement that contains no more than 10-15 mg of B .
▪ Some people experience nausea with levodopa. It may help to eat several small meals throughout the day, rather than the traditional 3 square meals. ▪ It is best to take levodopa on an empty stomach. However, if this makes you nauseous, a few crackers or a glass of ginger ale or juice may help. Do not eat anything containing fat or protein with your medication. The following foods contain large amounts of protein: – Meat, fish, and poultry – Dairy and dairy products (cheese, yogurt, etc) – Beans, nuts, and legumes – Eggs
Fava beans Fava beans contain naturally occurring levodopa, and many people with Parkinson’s disease have eaten them, with varying results. Some people report excellent results, while others report no results or adverse effects. Do not begin eating fava beans without talking to your doctor first. Under a doctor’s supervision, you might start with a very small amount and gradually increase your intake.
Some people have a genetic enzyme deficiency, commonly known as favism, which leads to hemolytic anemia in people who consume fava beans. It sometimes is fatal. Favism is most common in people of African, Mediterranean, and Southeast Asian ancestry. A lab test can determine whether you have this enzyme deficiency. Some people are allergic to fava beans, particularly in the raw form. If you are on a monoamine oxidase inhibitor (MAOI), you should not eat fava beans.
Dry mouth from medications Several medications used in the treatment of Parkinson’s disease can lead to dry mouth. The following tips may help: ▪ Use over-the-counter fluoride rinses. ▪ Keep sugarless candies, mints, or gum on hand. ▪ Moisten dry foods with gravy or broth. ▪ Make sure to drink 8-12 cups (C) of water/day. Risk of developing osteoporosis People with Parkinson’s disease are at increased risk for developing osteoporosis. Make sure you consume an adequate amount of foods containing calcium, magnesium, vitamin K, and vitamin D.
▪ Calcium is found in milk, dairy products, canned salmon with bones, cooked rhubarb, spinach, blackstrap molasses, almonds, oranges, calcium-fortified orange juice, broccoli, and enriched breads and grain products; however, calcium is best absorbed from dairy products ▪ Magnesium is found in seeds, nuts, legumes, and milk ▪ Vitamin K is found in broccoli, brussels sprouts, cabbage, turnip greens, and dark lettuces (Note: If you are on Coumadin® or another blood thinner, talk to you doctor before increasing your intake of these foods) ▪ Vitamin D is found in herring, salmon, milk, milk products, fortified cereal, canned sardines and shrimp, chicken and calf livers, and egg yolks; vitamin D also is absorbed from sun exposure ▪ If you dislike or cannot tolerate these foods, ask your doctor about the need for supplementation ▪ Consider having a bone density test ▪ Walking and other weight-bearing exercise helps to prevent skeletal weakening Constipation People with Parkinson’s disease often experience constipation. This is often caused by the medication used, but is also a symptom of the disease itself. The following tips may help with constipation: ▪ Eat plenty of fiber-containing foods, such as fruits, vegetables, whole-grain bread, cereals, beans, and legumes, aiming for 25-35 grams (g) of fiber/day ▪ Many people experience relief after eating a serving of prunes or drinking a glass of prune juice ▪ Make sure to drink plenty of fluids ▪ Exercise whenever you are able ▪ Talk to your doctor about using a fiber supplement, if you are not getting relief from the previous tips
Too tired to eat, no appetite, or nauseous If you find that you are too tired to eat, do not have an appetite, or are nauseous, try these suggestions: ▪ Make easy to prepare foods ▪ Prepare food when you feel good and freeze in single-serving portions, so meals are on hand on days when you feel tired ▪ Consider drinking a nutritional supplement on days when you do not feel well enough to eat as much as you normally do ▪ Avoid filling up on carbonated beverages before or during your meal—save your energy for nutrient-filled food ▪ Choose soft foods that do not require much chewing
▪ Select finger foods that do not require the use of silverware, which can take energy to manipulate ▪ Eat foods that offer the most calories, protein, vitamins, and minerals, such as the following good choices: – Cheese – Peanut butter – Whole milk – Ice cream – Dried fruits – Nuts – Fruit or vegetable juice – Instant breakfast mixes or medical nutritional products, such as Ensure® – Butter, cream cheese, jam, syrup, sour cream, and salad dressing to top your foods – Beans and lentils – Eggs—deviled eggs provide extra calories ▪ Speak to your doctor about treatment options, if you think that you might have depression ▪ Try to eat with other people whenever possible References and recommended readings Novartis. Living with Parkinson’s disease. Available at: http://www.stalevo.com/info/about/healthy_eating.jsp?usertrack.filter_applied=true&NovaId=33 50119519805007636. Accessed April 18, 2008. National Parkinson Foundation. Research, care, and hope, worldwide. Available at: http://www.parkinson.org/NETCOMMUNITY/Page.aspx?pid=201&srcid=-2. Accessed April 18, 2008.
Five Star Living, Inc. Nutrition you can live with. Available at: http://www.nutritionucanlivewith.com. Accessed April 18, 2008.
Gao X, Chen H, Fung TT, et al. Prospective study of dietary pattern and risk of Parkinson disease. Am J Clin Nutr [serial online]. 2007;86:1486-1494. Available at: http://www.ajcn.org/cgi/content/abstract/86/5/1486. Accessed April 18, 2008. Remig VM, Romero C. Medical nutrition therapy for neurologic disorders. In: Mahan LK, Escott-Stump S. Krause’s Food, Nutrition, and Diet Therapy. 11th ed. Philadelphia, PA: WB Saunders; 2004:1111-1113.
From NOVARTIS' Speech for Elidel Product Launch, March 2002 Marketing Overview/Treatment Options Day 2 PM General Session – Focus: The Market 20 minutes After musical number "Talkin’ Trash" there is a Voice Over introduction of speaker Too bad we can’t detail the physicians with that number. This afternoon’s General Session Focus is on The Market. Elidel’s p
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