Parkinson’s disease (PD) is a complicated disease, and while many people with PD live a long and healthy life, this is not the case for everyone. We’ve learned from a recent study1 that as many as 60% of people with PD are at increased risk for malnutrition. “Increased risk” doesn’t mean that 60% of people with PD will develop malnutrition; it just means that there is a higher possibility. But it is a good idea to be aware of the forms of malnutrition and their possible causes, so that you can minimize the risk.
Malnutrition is any disease that is caused by lack of nutrients, and can take many forms. Unplanned weight loss is one possibility. Deficiency of vitamin B12 can result in an Alzheimer’s-like dementia. Deficiency of other B vitamins can lead to insomnia, uncoordinated movement, depression, anorexia, confusion, memory loss. Lack of protein will cause the body to consume the proteins in its own muscle mass, causing wasting and weakness. Too little calcium, magnesium, or vitamins D or K result in osteoporosis. Without vitamin D, depression, dementia, falls, muscle aches and pains are possible.
What are the risks for malnutrition if you have Parkinson’s disease?
And how can we reduce these risks? Here are descriptions of some common nutrition-related concerns, followed by suggestions that may help to resolve the problems.
- One of the first symptoms of PD is loss of the sense of smell, a sense which is necessary in order to taste food. While lack of the senses of taste and smell doesn’t always affect appetite, it can become a factor.
- Suggestion: Choose favorite or especially desirable foods. Focus on flavor 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 flavor are lacking.
- Medications used to treat PD 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 crystallized ginger handy, to take while on errands or traveling. Even powdered ginger can be used to make tea.
- Medications may cause loss of appetite.
- Suggestion: Discuss this with your physician. If medication-induced, it may be possible to try a different medication.
- Depression is common among people with PD 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 may respond well to counseling. Some people may require antidepressant medication.
- The stage of PD can be a factor, because as PD progresses, symptoms often become more severe. Also motor fluctuations are more likely to occur in later-stage PD. Off-time, dystonia, and dyskinesia 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 you can time medications and meals more closely.
- Tremor and dyskinesia can burn extra calories.
- Suggestion: If using levodopa, divide the day’s protein needs among 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 problems increase fear, and risk, of choking.
- Suggestion: 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 if necessary recommend chopped, pureed, 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.
- 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.
- Chewing and swallowing become tiring and cause slowed eating, and inability to finish meals. It may take several hours to finish a meal.
- Suggestion: Choose foods that require little chewing. Include nutrient-rich blenderized smoothies, minced, mashed or pureed meats, fish, vegetables and fruits. For example, 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 disease 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 specialized health professionals, for their advice and support. With preparation and an experienced health care team, you can overcome, even prevent, common causes of malnutrition and related illness.
1 Tomic 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.