nutrition

How gut bacteria affect PD treatment

February 1, 2019 Education, Research

Patients with Parkinson’s disease are treated with levodopa, which is converted into dopamine, a neurotransmitter in the brain. In a study published on 18 January in the journal Nature Communications, scientists from the University of Groningen show that gut bacteria can metabolize levodopa into dopamine. As dopamine cannot cross the blood-brain barrier, this makes the medication less effective – even in the presence of inhibitors that should prevent the conversion of levodopa.

‘It is well established that gut bacteria can affect the brain’, explains Assistant Professor in Microbiology Sahar El Aidy, lead investigator of the study. ‘There is a continuous chemical dialogue between gut bacteria and the brain, the so called gut-brain axis.’ El Aidy and her team investigated the ability of gut microbiota to influence the bioavailability of levodopa, a drug used in the treatment of Parkinson’s disease.

The drug is usually taken orally, and the levodopa is absorbed in the small intestine and then transported through the blood stream to the brain. However, decarboxylase enzymes can convert levodopa into dopamine. In contrast to levodopa, dopamine cannot cross the blood-brain barrier, so patients are also given a decarboxylase inhibitor. ‘But the levels of levodopa that will reach the brain vary strongly among Parkinson’s disease patients, and we questioned whether gut microbiota were playing a role in this difference’, says El Aidy.

In bacterial samples from the small intestines of rats, Aidy’s PhD student Sebastiaan van Kessel found activity of the bacterial tyrosine decarboxylase enzyme, which normally converts tyrosine into tyramine, but was found to also convert levodopa into dopamine. ‘We then determined that the source of this decarboxylase was Enterococcus bacteria.’ The researchers also showed that the conversion of levodopa was not inhibited by a high concentration of the amino acid tyrosine, the main substrate of the bacterial tyrosine decarboxylase enzyme.

As Parkinson’s patients are given a decarboxylase inhibitor, the next step was to test the effect of several human decarboxylase inhibitors on the bacterial enzyme. ‘It turned out that, for example, the inhibitor Carbidopa is over 10,000 times more potent in inhibiting the human decarboxylase’, says El Aidy.

These findings led the team to the hypothesis that the presence of bacterial tyrosine decarboxylase would reduce the bioavailability of levodopa in Parkinson’s patients. To confirm this, they tested stool samples from patients who were on a normal or high dose of levodopa. The relative abundance of the bacterial gene encoding for tyrosine decarboxylase correlated with the need for a higher dose of the drug. ‘As these were stool samples, and the levodopa is absorbed in the small intestine, this was not yet solid proof. However, we confirmed our observation by showing that the higher abundance of bacterial enzyme in the small intestines of rats reduced levels of levodopa in the blood stream’, explains El Aidy.

Another important finding in the study is the positive correlation between disease duration and levels of bacterial tyrosine decarboxylase. Some Parkinson’s disease patients develop an overgrowth of small intestinal bacteria including Enterococci due to frequent uptake of proton pump inhibitors, which they use to treat gastrointestinal symptoms associated with the disease. Altogether, these factors result in a vicious circle leading to an increased levodopa/decarboxylase inhibitor dosage requirement in a subset of patients.

El Aidy concludes that the presence of the bacterial tyrosine decarboxylase enzyme can explain why some patients need more frequent dosages of levodopa to treat their motor fluctuations. ‘This is considered to be a problem for Parkinson’s disease patients, because a higher dose will result in dyskinesia, one of the major side effects of levodopa treatment.’

Article from University of Groningen.

For Caregivers: Nourishing Holidays

December 1, 2018 Caregivers, Life

Ah, “‘Tis the season….” But for many of us, it is another day of the same old thing, or, maybe worse, it is a time when there are even more expectations and responsibilities placed upon us than we usually face. May be they come from inside, or maybe they are expectations from others, none-the-less, the holiday season can be more burdensome than joyful for many of us.

Hopefully, you can make some time for yourself for inner reflection—Some time to consider things or people that you are grateful for and some things that you would like to do a little differently in your future. It may even be a little more important now that we are entering a new Millennium!

So, I invite you to consider your relationship with food! Some of you may scratch your head “Relationship” with food? I have relationships with people or pets, not food!” This may be true for the many of us who truly view food as a means of sustenance – You may know folks who truly don’t care what they eat and may even forget to eat, unless someone reminds them or prepares it for them. There are those of us, however, for whom foods, especially certain foods, seem to have a voice in our heads. It may sound like “I’m here waiting for you to eat me – please don’t leave me in this half empty bag (or container) in the dark all night” or “Oh, it’s the holidays and we both know I’m not good for you. Still, this once, just a little bit won’t hurt….”

As a nutritionist, I often speak to people about the nutrients and nutrition in the food they eat. I am growing in my understanding that there is a lot more to food than just the chemicals that make up the protein, fat, vitamins and minerals. In a book called Nourishing Wisdom, the author, Marc David, very nicely shows how the psychological and spiritual aspects of our lives affect how and if we are truly nurtured. In his book, Mr. David suggests that we need to experience food as a neutral thing – no “good” or “bad” food – and instead, listen to our bodies to know what to eat. The foods we humans eat are greatly influenced by our culture and psychology, rather than by instinct. Our bodies want, and need, different foods at different times. We prefer salads and light foods in the summer and soups and heavier foods during the colder, darker winter months. There may be times when we are happy or sad that we want a certain food, because it is familiar to us or associated with similar circumstances in our past.

At holiday times, we look forward to special foods. Why? For many of us, they remind of us happy times, special times and, perhaps, times when someone else was responsible for the cooking! These special foods have the capacity to nourish us in more ways than just giving us calories and vitamins and minerals. For each of us, we long to belong, to know we are important to someone or that we have made a difference in someone’s life. If, somehow, we are not sure of these things, we may turn to eating certain foods to feel comforted or to preparing foods for others to be sure we are needed and appreciated.

As we grow older, many of us are faced with chronic diseases like high blood pressure, heart disease or diabetes. We may find it harder to maintain our youthful figures… And still, each year the Holidays come around, luring us with their many treats, treats that often are not very healthy for us in the long run.

Instead of feeling compelled to eat one more cookie or sliver of pie, and then feel guilty about it, please consider this instead. Take a few seconds to ask yourself, “Am I really hungry for this? …How will I feel later, if I eat this now?” Or “Do I need it right this minute? Could I wait till later when I’m not so full?” It will just take a few seconds and it may save you from feeling bad for a lot longer later! And, as any thing new you try, you will forget sometimes. Do not worry about that! Celebrate the times you remember – Celebrate the times you remember to take care of yourself!

As you are shopping at the bakery or getting out your family’s favorite recipes full of butter and sugar, ask yourself, “How can I make this recipe a little healthier—and still taste good? What’s important here? Is it that we have the same foods that taste the same, or is it that we celebrate life and its many pleasures and treasures and challenges this past year has brought?” If that’s what the holidays are about, then it may not matter what foods are on the table, healthy or not. But it may matter, in the long run, if you feel good about yourself, because you know that taking care of your health and the health of your loved ones is a year round commitment.

Article from Today’s Caregiver.

Lifestyle Changes in Improving Quality of Life in PD Patients

February 1, 2018 Exercise, Life

In this video, Susan H. Fox, MB ChB, MRCP(UK), PhD discusses the importance of lifestyle in dealing with PD, emphasizing the importance of sleep and exercise.

Video from Panorama Patient Network.

Super foods: what to eat to help prevent anxiety in Parkinson’s

December 1, 2017 Change, Education, Life

We know that people with Parkinson’s can often experience non-motor symptoms such as anxiety and panic disorders. However, there is evidence to suggest that a diet rich in certain nutrients can help alleviate some of these difficulties.

Iron-rich foods

Animal foods with a high iron value include beef, beef liver, pork, poultry, and seafood such as halibut, haddock, perch, salmon, tuna, clams, and oysters. These contain heme iron, which is found in animal meat and is more readily absorbed than plant-derived, non-heme iron. Too much iron can interfere with levodopa absorption, and because these foods are also high in protein, they can block levodopa. If you use levodopa, be sure to take it at least 30 minutes before eating these foods. Fish and seafood are good choices for people with Parkinson’s because they also contain brain-supportive omega-3 fatty acids.

Plant foods high in iron include soybeans, tofu, lentils, spinach, chard, garbanzo beans. These have the non-heme form of iron, which is less well absorbed than heme iron. Acidity helps boost iron absorption, so having lemon juice or vinegar salad dressing, or an orange, in the same meal with beans and leafy greens will help you get the most iron absorption from the plant food.

According to the Food and Nutrition Information Center of the United States Department for Agriculture (USDA), the Recommended Dietary Allowance (RDA) for iron is 8mg per day for men aged 19 and older, 18mg per day for women between the ages of 19 to 50, and 8mg per day for women aged 51 and older.

Food high in vitamin B6

Tuna, turkey, beef, chicken, salmon, sweet potato, potatoes, sunflower seeds, spinach and other dark leafy greens, and bananas are all good sources of vitamin B6. Tuna, beef, poultry, salmon, and spinach are good iron sources also, so these foods provide the benefit of both nutrients.

The RDA of vitamin B6 is 1.3mg for men between the ages of 14 to 50 and women between the ages of 19 to 50. Men above the age of 50 require 1.7mg, while women of the same age need 1.5mg.

Foods rich in vitamin D

There are few foods that contain vitamin D, and of these, salmon is by far the best – a salmon steak of 115g contains 128% of the RDA. Sardines, cow’s milk, tuna, egg yolks, and shiitake mushrooms have smaller but still important amounts. Salmon is a great food to eat two to three times weekly and it’s also a source of vitamin B6 and iron too. Sunlight is a very good source of vitamin D. When sunlight is available, exposing your face and arms for around 10 minutes a day will provide sufficient amounts.

The RDA for vitamin D for all adults between the ages of 19 to 70 years is 600 IU per day. For those above the age of 71 the RDA is 800 IU per day. If taking supplements choose the vitamin D3 form, which is more easily absorbed than the D2 form.

Article from Parkinson’s Life.

9 Power Foods that Boost Immunity

November 1, 2017 Life

You’re washing your hands, using Purell like crazy, and sneezing into your elbow. Now add these superfoods to your diet for an extra flu-fighting punch.

It takes more than an apple a day to keep the doctor away. It turns out that eating some pretty surprising nutrients will help keep your immune system on guard.

You can ensure your body and immunity run smoothly by rounding out your plate with plenty of colorful servings of fruits and veggies, plus 8 to 10 glasses of water a day, at the very least. The following ingredients can add extra flu-fighting punch to your winter meal plan.

Probiotics, or the “live active cultures” found in yogurt, are healthy bacteria that keep the gut and intestinal tract free of disease-causing germs. Although they’re available in supplement form, a study from the University of Vienna in Austria found that a daily 7-ounce dose of yogurt was just as effective in boosting immunity as popping pills. In an 80-day Swedish study of 181 factory employees, those who drank a daily supplement of Lactobacillus reuteri—a specific probiotic that appears to stimulate white blood cells—took 33% fewer sick days than those given a placebo. Any yogurt with a “Live and Active Cultures” seal contains some beneficial bugs, but Stonyfield Farm is the only US brand that contains this specific strain.

Your optimal dose: Two 6-ounce servings a day.

These grains contain beta-glucan, a type of fiber with antimicrobial and antioxidant capabilities more potent than echinacea, reports a Norwegian study. When animals eat this compound, they’re less likely to contract influenza, herpes, even anthrax; in humans, it boosts immunity, speeds wound healing, and may help antibiotics work better.

Your optimal dose: At least one in your three daily servings of whole grains.

This potent onion relative contains the active ingredient allicin, which fights infection and bacteria. British researchers gave 146 people either a placebo or a garlic extract for 12 weeks; the garlic takers were two-thirds less likely to catch a cold. Other studies suggest that garlic lovers who chow more than six cloves a week have a 30% lower rate of colorectal cancer and a 50% lower rate of stomach cancer.

Your optimal dose: Two raw cloves a day and add crushed garlic to your cooking several times a week.

Selenium, plentiful in shellfish such as oysters, lobsters, crabs, and clams, helps white blood cells produce cytokines—proteins that help clear flu viruses out of the body. Salmon, mackerel, and herring are rich in omega-3 fats, which reduce inflammation, increasing airflow and protecting lungs from colds and respiratory infections.

Your optimal dose: Two servings a week (unless you’re pregnant or planning to be).

When University of Nebraska researchers tested 13 brands, they found that all but one (chicken-flavored ramen noodles) blocked the migration of inflammatory white cells—an important finding, because cold symptoms are a response to the cells’ accumulation in the bronchial tubes. The amino acid cysteine, released from chicken during cooking, chemically resembles the bronchitis drug acetylcysteine, which may explain the results. The soup’s salty broth keeps mucus thin the same way cough medicines do. Added spices, such as garlic and onions, can increase soup’s immune-boosting power.

Your optimal dose: Have a bowl when feeling crummy.

People who drank 5 cups a day of black tea for 2 weeks had 10 times more virus-fighting interferon in their blood than others who drank a placebo hot drink, in a Harvard study. The amino acid that’s responsible for this immune boost, L-theanine, is abundant in both black and green tea—decaf versions have it, too.

Your optimal dose: Several cups daily. To get up to five times more antioxidants from your tea bags, bob them up and down while you brew.

Zinc deficiency is one of the most common nutritional shortfalls among American adults, especially for vegetarians and those who’ve cut back on beef, a prime source of this immunity-bolstering mineral. And that’s unfortunate, because even mild zinc deficiency can increase your risk of infection. Zinc in your diet is very important for the development of white blood cells, the intrepid immune system cells that recognize and destroy invading bacteria, viruses, and assorted other bad guys, says William Boisvert, PhD, an expert in nutrition and immunity at The Scripps Research Institute in La Jolla, CA.

Your optimal dose: A 3-oz serving of lean beef provides about 30% of the Daily Value (DV) for zinc. That’s often enough to make the difference between deficient and sufficient. Not a beef person? Try zinc-rich oysters, fortified cereals, pork, poultry, yogurt, or milk.

You may not think of skin as part of your immune system. But this crucial organ, covering an impressive 16 square feet, serves as a first-line fortress against bacteria, viruses, and other undesirables. To stay strong and healthy, your skin needs vitamin A. “Vitamin A plays a major role in the production of connective tissue, a key component of skin,” explains Prevention advisor David Katz, MD, director of the Yale-Griffin Prevention Research Center in Derby, CT. One of the best ways to get vitamin A into your diet is from foods containing beta-carotene (like sweet potatoes), which your body turns into vitamin A.

Your optimal dose: A half-cup serving, which delivers only 170 calories but 40% of the DV of vitamin A as beta-carotene. They’re so good, you might want to save them for dessert! Think orange when looking for other foods rich in beta-carotene: carrots, squash, canned pumpkin, and cantaloupe.

For centuries, people around the world have turned to mushrooms for a healthy immune system. Contemporary researchers now know why. “Studies show that mushrooms increase the production and activity of white blood cells, making them more aggressive. This is a good thing when you have an infection,” says Douglas Schar, DipPhyt, MCPP, MNIMH, director of the Institute of Herbal Medicine in Washington, DC.

Your optimal dose: Shiitake, maitake, and reishi mushrooms appear to pack the biggest immunity punch; experts recommend at least ¼ ounce to 1 ounce a few times a day for maximum immune benefits. Add a handful to pasta sauce, sauté with a little oil and add to eggs, or heap triple-decker style on a frozen pizza.

Article from Prevention.com.

Parkinson’s and malnutrition: what are the risks and how do you prevent it?

June 1, 2017 Caregivers, Education, Life

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.

Seeking helpFor 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.

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

31st Annual Parkinson Disease Symposium | June 23, 2017

June 1, 2017 Awareness, Caregivers, Community Outreach, Education, Life, Research

WPA will host its 31^st Annual Parkinson Disease Symposium on Friday, June 23, 2017 at Country Springs Hotel & Conference Center in Pewaukee, Wisconsin.

Beginning at 8:00am, attendees can check in and visit with vendors at the Resource Fair where health and community agencies will display valuable information throughout the day. Beginning at 9:00am, the first main session will be “Understanding Parkinson Disease from a Scientific Perspective”, presented by Giuseppe P. Cortese, PhD, Postdoctoral Research Associate, Department of Neurology, University of Wisconsin-Madison. The morning breakout sessions will follow Dr. Cortese’s interactive presentation, and participants will choose from three options: “Caregivers: Being prepared for an emergency”, “Grieving ‘life as we have known it’”, and a Panel on PD exercise programs.

During lunch, the resource fair will again be open for participants. After lunch, the afternoon breakout sessions will include “Are you caring too much and laughing too little?”, “Causes and prevention of falls” and “Exercise: A targeted attack on Parkinson’s.” The closing session for all attendees will be “Nutrition for Parkinson Disease” presented by Michelle McDonagh, RD, CD, Froedtert & The Medical College of Wisconsin. The Symposium will conclude by 3:30pm.

The registration fee is $30 per person and includes educational materials, continental breakfast, and lunch. To register, CLICK HERE or call our office at 414-312-6990. Registration is required and must be received by Wednesday, June 14.

The event is sponsored by Abbvie, Medtronic and US WorldMeds.

How gut bacteria affect PD treatment

For Caregivers: Nourishing Holidays

Lifestyle Changes in Improving Quality of Life in PD Patients

Super foods: what to eat to help prevent anxiety in Parkinson’s

9 Power Foods that Boost Immunity

Parkinson’s and malnutrition: what are the risks and how do you prevent it?

31st Annual Parkinson Disease Symposium | June 23, 2017

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31st Annual Parkinson Disease Symposium | June 23, 2017