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 pureed 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.
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.
http://parkinsonslife.eu/parkinsons-and-malnutrition-risks-and-prevention/