Staying nourished with Parkinson’s disease

Research estimates that more than 110,000 Australians may be living with Parkinson’s disease, a neurodegenerative disorder characterised by reduced control of fine motor skills, tremors, slowness of movements, impaired mobility, swallowing issues and impaired speech. As a result, staying nourished and maintaining healthy eating habits can be challenging for those living with Parkinson’s disease.

MAINTAIN A HEALTHY WEIGHT
Preventing unwanted weight gain plays an important role in maintaining mobility and independence with everyday tasks, particularly if balance and coordination is affected. Similarly, preventing unwanted weight loss and muscle wasting is fundamental to maintaining muscle strength, balance and therefore mobility.

Under the guidance of an accredited practising dietitian (APD), oral nutrition supplements for weight gain and weight maintenance may be required. For some Parkinson’s medications such as levodopa, absorption can be affected by the presence of protein in the diet. This interference between protein and levodopa does not affect everyone with Parkinson’s disease. It is therefore important to monitor ‘on/off’ symptoms and adjust the timing of meals and supplements with Parkinson’s medication. Generally, administration of Parkinson’s medication is encouraged at least 30 minutes prior to meals to maximise absorption.

NAUSEA
Nausea is a common side-effect of levodopa. This normally subsides once the body adjusts to the medication. If nausea is experienced, the following strategies can be tried:

• In the beginning, taking medication with food.
• Consume smaller, more frequent meals.
• Minimise aromatic foods if the smell is nauseating.
• Some evidence supports the consumption of ginger-based products to alleviate nausea.
• Avoid taking anti-nausea medications like Maxolon which block the effectiveness of levodopa. Always talk to your pharmacist or medical specialist before starting new medication.

FATIGUE AND REDUCED APPETITE
If fatigue is a factor in meal preparation, patients can cook meals in bulk when energy levels are best and freeze for later, utilise meal services, or enlist the help of a friend or family member.

If fatigue is affecting the ability to eat, try cooking softer foods that require less effort to chew, finger foods, or swapping the main meal to a time of day when energy levels are best.

TREMORS AND INVOLUNTARY MOVEMENTS
A common side effect of levodopa is involuntary movements (dyskinesia). These movements burn energy (kilojoules) the same way exercising would and therefore require an increase in oral intake if weight loss is not desired.

An APD can provide support and may recommend oral protein supplements and/or fortifying meals with additional toppings, sauces, gravy or protein powder.

For severe dyskinesia, it may be worthwhile monitoring symptoms with medication timings so that the specialist can fine-tune medication regimens.

Repetitive movements such as feeding, chopping or whisking may also be hindered. An occupational therapist can discuss options for modified equipment, such as double-handled mugs, modified cutlery, plate guards and so on.

SWALLOWING ISSUES
Fatigue and incoordination of movements may affect a patient’s ability to chew food. Likewise, slowing of the muscles that control swallowing may lead to delayed swallowing and increased risk of food particles reaching the lungs. This slowing of the muscles is known as a condition called bradykinesia.

Consulting a speech pathologist is recommended if there are issues with chewing or swallowing ability. The speech pathologist may recommend a change in diet texture or fluid thickness.

Careful consideration to food provision should be paramount with texture-modified diets to ensure optimum intake. This may include the use of food moulds for pureed consistencies to increase the attractiveness and palatability of the meal.

CONSTIPATION
Bradykinesia that affects the gut’s ability to transit food may lead to constipation and/or early satiety at meal times. Constipation is a common issue in those living with Parkinson’s and can compound nausea and poor appetite. A regular bowel regimen utilising aperients may be required to ensure regularity. The addition of adequate hydrating fluids and high fibre foods may assist with softening motions.

LOSS OF SMELL
Probably the most common symptom of Parkinson’s disease is a change to sense of smell (anosmia). Ability to smell food contributes to the flavour and subsequently enjoyment of food.

If anosmia is present, try adding extra flavourings to food such as spices, herbs, sauces, gravy and salt to encourage intake.

TALK TO A DIETITIAN
Consulting an APD is encouraged to ensure adequate nutrition.

In extreme cases, artificial feeding may be required via a tube feed. Given that those with Parkinson’s are more than five times as likely to be in residential aged care facilities than the general population, adequate nutrition plays a pivotal role in ensuring people with Parkinson’s disease achieve a higher quality of life.

To find a local APD, visit daa.asn.au, click ‘Find an APD’ and choose ‘Aged Care’ under ‘Area of Practice’, or free call 1800 812 942.

Samantha Ling has a Bachelor of Food Science and Human Nutrition and a Master of Nutrition and Dietetics. She has nearly seven years’ experience working as a clinical dietitian within aged care consulting, individual nutrition counselling and small group education. She is the senior clinical dietitian at a well-renowned rehabilitation private hospital on Sydney’s North Shore and is a clinical dietitian at a private hospital on NSW’s Central Coast.

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