Parkinson’s and malnutrition: what are the risks and how do you prevent it?
Recipes & Nutrition
Author: Kathrynne HoldenPublished: 17 May 2017
Prep: -Cook: -Serves: -
Our regular guest nutritionist, Kathrynne Holden, explains why people with Parkinson’s can be at risk of malnutrition and describes some of the steps that can prevent it from happening
Parkinson’s is a complicated condition and while many people with Parkinson’s live a long and healthy life, this is not the case for everyone. A recent study found that possibly as many as 60% of people with Parkinson’s are at increased risk for malnutrition.1 “Increased risk” doesn’t mean that 60% of people with Parkinson’s will develop malnutrition, it just means that there is a higher possibility of malnutrition – but it is a good idea to be aware of all its possible causes, so that you can minimise the risk.
The risks and how to minimise them
Below are descriptions of some common nutrition-related concerns that may occur as a result of Parkinson’s, followed by suggestions that could help to resolve the problems.
Sense of smell One of the first symptoms of Parkinson’s can be loss of the sense of smell, a sense that is necessary in order to taste food. While lack of taste and smell doesn’t always affect appetite, it can become a factor.
Suggestions: Choose favourite or especially desirable foods. Focus on flavour intensity – lemon, garlic, soy sauce, cinnamon, cloves, nutmeg, herbs; and “mouthfeel” – foods that are crunchy, creamy, chewy or have other appealing textures that make them more agreeable when scent and flavour are lacking.
Feeling nauseous Medications used to treat Parkinson’s often cause nausea.
Suggestion: Ginger is very effective at counteracting nausea. Keep some fresh ginger in the freezer and use it to make ginger tea, or chew a slice of ginger. Keep a container of crystallised ginger handy, to take while on errands or travelling. Even powdered ginger can be used to make tea.
Medication regimes Medications may cause loss of appetite.
Suggestion: Discuss this with your physician. If medication-induced, it may be possible to try a different medication.
Low mood Depression is common among people with Parkinson’s and can affect willingness to eat.
Suggestion: Discuss this with your physician. Depression can be due to deficiency of B vitamins, vitamin D, omega-3 fatty acids, or other nutrients – a blood test will show whether this is the case and, if so, supplements should help. In some cases, depression can be alleviated by attending regular counselling sessions, however, some people may require antidepressant medication.
Late-stage Parkinson’s The stage of Parkinson’s can be a factor, because as it progresses, symptoms often become more severe. In addition, motor fluctuations are more likely to occur in later-stage Parkinson’s. ‘Off’-time, dystonia, and dyskinesia can make it difficult both to eat, and to time medications and meals.
Suggestion: Ask your doctor about a longer-lasting medication, such as Stalevo, or Rytary, or a pump, so that ‘off’ time is reduced and the timing of medications and meals is more regulated closely.
Calorie deficit Tremor and dyskinesia can burn extra calories.
Suggestions: If using levodopa, divide the day’s protein needs between morning, midday, and evening meals, taking levodopa about 30 minutes before each meal. In between meals, eat small, non-protein or low-protein snacks, such as fruits and juices, whole-grain crackers or biscuits, tomato or vegetable soup. These add extra calories without blocking levodopa absorption.
Swallowing and choking issues Swallowing problems increase fear and risk of choking.
Suggestions: Ask your doctor for a referral to a speech pathologist, who can evaluate your swallowing function, and determine whether you are at risk for choking. If so, the therapist can demonstrate safe swallowing techniques, and recommend chopped, puréed, or otherwise altered foods and liquids. You should also be referred to a dietitian, who can assess your needs and ensure you are getting enough protein and other nutrients.
Motor problems in hands Rigidity and loss of manual dexterity makes it hard to manage eating utensils.
Suggestion: Ask your doctor for a referral to an occupational therapist, who can recommend specially designed plates, bowls, drinkware, and eating utensils that are easier to manage.
Slowed eating Chewing and swallowing become tiring, cause slowed eating and inability to finish meals. It may take several hours to finish one meal, so the person is unable to consume enough calories during a day to maintain health.
Suggestion: Choose foods that require little chewing. Include nutrient-rich blended smoothies, minced, mashed or puréed meats, fish, vegetables and fruits such as meatloaf, applesauce, mashed peas, potatoes, carrots, or baby foods. If this is insufficient, ask your doctor about placement of a feeding tube. In many cases, individuals can still eat and enjoy food by mouth; but the feeding tube ensures sufficient fluids to prevent dehydration, and enough protein, vitamins, and minerals for complete nutrition.
For some people, Parkinson’s may present barriers to good nutrition. These can be difficult to deal with. Being aware of such possibilities is important, so that you can prepare as needed. That includes close communication with your neurologist, and the help of specialised health professionals, for their advice and support. With preparation and an experienced healthcare team, you can overcome, – or even prevent – common causes of malnutrition and related illness.
References 1Tomic S1, Pekic V2, Popijac Z3, Pucic T3, Petek M2, Kuric TG2, Misevic S3, Kramaric RP2. What increases the risk of malnutrition in Parkinson’s disease? J Neurol Sci. 2017 Apr 15;375:235-238.
Kathrynne Holden, a registered dietitian, has specialised in Parkinson’s disease nutrition for over 20 years. She has contributed to two physicians’ manuals on Parkinson’s, written the booklet ‘Nutrition Matters’ for the NPF (with some of her work for them archived here). Now retired, she maintains a website on Parkinson’s topics.
We talk to adventurer Alex Flynn about his incredible achievements
4 days ago
Is there a link between Parkinson’s disease and blood vessel dysfunction?
Scientists in Slovakia have investigated the link between blood vessel dysfunction and Parkinson’s – and found that dopamine agonists may have an impact. The team studied the function of the endothelium – a membrane which lines the heart and blood vessels and helps control blood fluidity – in 41 people with the condition and 41 people without. Endothelial function was then measured through a parameter that assessed how easily blood could flow through the vessels. The results showed that while more people with Parkinson’s had endothelial dysfunction compared to those without, the difference did not reach statistical significance. However, the researchers noted that the findings suggested “an association between smoking, dopamine agonists, and impaired endothelial function” in those with the condition. Outlining the study’s limitations, the team noted that more research is needed to explore this potential link.
New swab test may help with Parkinson’s disease diagnosis
Researchers at the University of Manchester, UK, have drawn on one woman’s sense of smell to develop a swab test that may be used to detect Parkinson’s. The scientists used the test to analyse sebum (a type of oily substance on the skin) in 79 people with Parkinson’s and a control group of 71 healthy individuals. The team identified more than 4,000 different compounds in the participant samples – including 500 that were unique to those living with the condition. The test was developed with the help of Joy Milne from Perth, Scotland, whose unique sense of smell meant that she noticed a change in her late husband Les’s odour twelve years before he was diagnosed with Parkinson’s. Speaking to the BBC, Professor Perdita Barran, who led the research, described the test as potentially “transformative” – and said that the team hopes to roll the test out to people in…
Could a national biobank help inform the future of Parkinson’s disease treatment in Australia?
A biobank is a collection of biological samples and data designed to be used for research. Now, researchers in Australia are working to build a biobank for Parkinson’s. As part of the project, the scientists are conducting scans of people that have been injected with fluorodopa – a substance that highlights dopamine in the brain. Participants include people living with Parkinson’s and a control group of people without the condition. The resulting database of scans will be used to create a national biobank that aims to inform treatment and research into the condition. Commenting on the study, Olivia Nasser – executive director at the Hospital Research Foundation, which is helping to fund the research – said, “Once we build up the biobank of scans, it can actually be used as an effective way to treat Parkinson’s.” The researchers encourage people with and without Parkinson’s to take part in the trial.