One question that get all the time, is how to manage their diet with medications, protein, and their Parkinson’s symptoms. Today, I am thrilled to bring you someone who knows Parkinson’s disease, was a registered dietitian, has written and advised extensively on the subject of Parkinson’s and diet (I am vegetarian and some of the following recipes are my guest’s suggestion), and now, will share her knowledge with you! I am so excited to present my interview with Kathrynne Holden:
Question 1: What pointed your focus in nutrition to Parkinson’s? Was it a personal focus for a loved one or a need that you saw that had to be addressed?
I discovered a need that had to be addressed. In university, we studied medical nutrition therapy for heart disease, cancer, diabetes, stroke, and many other conditions; also food-medication interactions, of great importance for dietitians. After graduation I offered free counseling at our senior center, and a gentleman asked if there was any special diet for Parkinson’s disease. In seven years of study I had never heard of Parkinson’s disease, so I said I would do some research and get back to him. What I learned on Medline was staggering. There was a vast array of nutritional obstacles, including a major food-medication interaction: levodopa and protein. Yet there were no nutritional guidelines, either for patients or health professionals. I determined to narrow my focus to Parkinson’s disease alone. In the process, I coauthored research, wrote two manuals for dietitians as well as books for people with Parkinson’s and their families, and contributed to two physician’s manuals on Parkinson’s. Currently several of us are petitioning our parent organization, the Academy of Nutrition and Dietetics, to include Parkinson’s Disease as a condition requiring nutrition therapy. If successful, insurance coverage might be a result as well.
Question 2: What should every person with PD know about diet and this illness?
Karl: Maybe, you can list a few suggestions. For me, I noticed that my meds efficacy and my digestion improved from being a long-time vegetarian. I discovered that my pills activated faster when I took them with caffeine and that Not until I visited Hawaii did I find out that Macadamia nuts were a natural laxative. These were helpful tidbits that I had to find on my own.
Kathrynne: Karl, you’ve hit on one of the most important points. Medication effectiveness, digestion, and constipation are concerns for almost everyone. But the solutions can be quite different from one person to the next. And no one knows you as well as you do, so it’s important to be your own detective, and learn what works best for you. But here are some points to consider.
For constipation, besides fluids and a high-fiber diet, some foods that can help include, as you note, macadamia nuts, kiwifruit, cashew nuts, cooked prunes, beets, flax seed, whole grains, and well-soaked chia seeds. You’ll need to experiment to find what works best for you.
For those using levodopa, some people report that taking it with a carbonated drink such as seltzer water speeds its absorption.
It’s also important to take levodopa 30 minutes before meals containing protein, so it can dissolve and enter the small intestine for quick absorption. Do not take it with, or right after, meals, because the stomach hasn’t emptied and the levodopa can’t pass through to the small intestine. Also, because Parkinson’s can slow the motion of the gastrointestinal tract, it can take 90 minutes or longer for the stomach to empty. If it doesn’t seem like your levodopa is effective, it may be due to slowed stomach emptying, a question to discuss with your doctor.
Also, when timing of meals and levodopa is complicated it can help to use quick-absorbing “liquid levodopa.” The Parkinson Foundation has instructions for making it. Go to Parkinson’s Disease Medications: https://f5h3y5n7.stackpathcdn.com/sites/default/files/attachments/Medications.pdf On page 73 find the “Formula for Liquid Sinemet.”
Question 3: We are all very different in our symptoms, medicines, and stages of illness but is there a universal truth that can benefit all our diets?
Yes. It’s important to realize the value of whole foods, as opposed to vitamin and mineral supplements. Parkinson’s is a stressful condition, and stress, along with other conditions, creates “free radicals” – very reactive particles that cause damage in the body and brain. But antioxidants stabilize free radicals, making them harmless.
Foods are a much better source of antioxidants than supplements, because foods contain substances that support each other and make the antioxidant more effective. For example, a Brazil nut contains vitamin E, which you can also get from a pill. But the Brazil nut contains the entire array of tocopherols and tocotrienols that make up vitamin E, and it also contains selenium, an antioxidant mineral that works with vitamin E, forming an antioxidant combination much more powerful than either one alone.
Vegetables, fruits, and nuts are rich in antioxidants, as well as fibers that both help prevent constipation and serve as food for our “friendly bacteria” known as the microbiome. Some good examples are berries, grapes, plums both fresh and dried (prunes), carrots, beets, blue corn, broccoli, pecans, bell peppers. Another excellent food is fatty fish, such as salmon, for omega-3 fatty acids that benefit the brain.
Here are links to recipes using some of these foods, by George Mateljian, whose work in nutrition is excellent, I’m a great fan:
Sautéed Vegetables with Cashews
Super Carrot Raisin Salad
5- Minute Blueberries with Yogurt
5-Minute “Quick Broiled” Salmon
Question 4: It is believed that Parkinson’s disease begins in the gut. Have you seen diet make an impact on your client’s symptoms as well as progression?
It seems likely that PD may begin in the gut via the vagus nerve, which is a pathway from the digestive tract to the brain. In an analysis, researchers found that individuals whose vagus nerve was severed were at a much lower risk for developing PD. But scientists believe that there are likely to be other causes besides the gut-brain pathway. Some also theorize that unhealthy gut microbes may communicate to the brain by way of the vagus nerve, and that maintaining a healthy microbiome might lower risk of PD.
Regarding diet’s impact on PD, yes. Persons with PD who turn to wholesome, nourishing foods, have offered such comments as “digestion has improved,” “PD symptoms have lessened,” “depression has lifted.” It appears that with a good diet, medications can be more effective, and there is a general sense of improved well-being.
It’s possible that this could be due to nourishing the gut microbiome – the colony of microorganisms that live in our gastrointestinal tract. We now know that dietary fibers are food for these beneficial microbes, keeping them in good health. They can then communicate with our DNA to influence our health. A healthy microbiome appears to help prevent the inflammatory bowel disease and irritable bowel syndrome that so often plague people with PD. It fights cancer, and may be a factor in preventing some types of depression. Some strains produce a dopamine byproduct that is associated with better mental health.
But they need to be fed the proper food – dietary fiber – in order to do their work. That’s why whole grains, vegetables, and fruits are so important, and why refined flour and sugar and highly-processed foods are so harmful – they leave nothing for the microbiome to feed on. I recommend eating a variety of whole grains, vegetables, and fruits, because each has different fibers, and the various types of microbes each need their own kind of fiber.
Question 5: What should we be avoiding in our diets to get the most from our food and to assist our medications?
I would avoid what I call “anti-foods” – those that are made from refined, highly-processed ingredients like white flour and sugar, hydrogenated fats, and artificial colorings and flavorings. Many of the ready-to-eat frozen meals and canned soups fall into this category.
Also, as much as possible I would avoid produce grown with herbicides and pesticides in favor of organically-grown produce. There is a growing association between pesticide and herbicide use and risk for Parkinson’s disease. Organic foods are often more expensive, but the Environmental Working Group posts a list of foods that are the most and least contaminated. See their website: https://www.ewg.org/foodnews/summary.php Good food will never let you down.
My thanks to Kathrynne Holden for making this interview possible. I am very appreciative that she shared so much great information on diet and Parkinson’s disease with us! I hope you find this interview helpful. Eat Well!
Kathrynne Holden, MS, RD (retired) is author of “Eat Well, Stay Well with Parkinson’s Disease,” “Cook Well, Stay Well with Parkinson’s Disease” and “Parkinson’s Disease and Constipation (CD)” See her blog at nutritionucanlivewith.com for more on nutrition for Parkinson’s disease.
Last week, I had the opportunity to speak to a wonderful audience with Parkinson’s and their care partners, in eastern Virginia. It was a marvelous exchange of information and emotions. Parkinson’s disease comes with so many unwritten rules. Trying to find all that you need to know about this illness, all in one place, may be frustrating to collect. There is so much to remember and so much that you might forget. Staying on top of Parkinson’s disease, symptoms, medications, and health maintenance, is a full-time job!
The following are 5 pieces of knowledge that you will want to remember:
Is your neurologist a movement disorder specialist? If you have Parkinson’s disease and your neurologist isn’t a movement disorder specialist, you may want to see if there is one in your area. Movement Disorder Specialists complete extended training to focus on neurological disorders like Parkinson’s disease.
If you are taking antibiotics, your medication’s effectiveness may be hindered dramatically. I can speak from experience that after taking antibiotics for my tooth infection, I saw a huge decline in the efficacy of my daily regimen of Parkinson’s medications.
Don’t forget that if you are on Sinemet and you are protein-sensitive (protein in your diet may interact with your Levodopa), protein may decrease the full benefit of your dose. You may want try taking your protein later in the day or evening. Timing your medications for optimal benefit is part science, part art, and part luck.
When I am able to lower my stress level, I have found that medications work better, I feel calmer and more peaceful, and see less of my symptoms.
Eat smart and healthy! Talk to your doctor about how to improve your gut health.
In the near 200 years, since the discovery of Parkinson’s Disease (PD), the theories of how, where, when, and why the illness develops varies over time. Science is proving and re-enforcing the belief that everything is connected. When I was officially diagnosed in 1991 with PD, there were only a few doctors who pondered the connection between the gut and the brain. Now, there seems to be a much larger contingent who agree that our gut plays a major factor in our brain function.
The body has a mysterious way of masking itself or maybe it is just due to the complexity of the brain. For several years, my right shoulder rotator cuff hurt and I was unable to find long-lasting relief or an answer to where the pain was coming from. I had seen doctors, taken X-rays, seen massage therapists, and done physical therapy, and all proved to do little, over time. I was sure the pain resided in the shoulder. I was wrong.
I had to go all the way across the United States to find relief. A knowledgeable and very intuitive massage therapist who really paid attention to my arm discovered a very sore spot close to the mid point of my upper arm. Once she released the extreme pain that had been stored in that one spot, the pain in my shoulder dispersed. I would call the results near miraculous. She found the cause of my pain where no one had even thought of looking.
I think that this is sound evidence that there is just so much about the systems of the human body that we just can’t understand, just yet. Over time, new discoveries and breakthroughs may very well reveal astounding relationships between our systems or even unveil how our bodies process certain chemicals and alter our central nervous system. Until the day comes that modern science is capable of unveiling an all encompassing cure, it is our responsibility for exploring our own systemic connections, the roles that stress and anxiety play in our lives, our diets, our sleep patterns, and even how we think, feel, and react.
Our mind, body, and spirit depend upon one another. Maintaining that delicate balance is the key to our health. Finding the missing pieces that might lead us to fulfill the balance may require exploration and investigation outside our comfort zone and even that of our complete understanding. What I thought originated in my shoulder was actually being manipulated by a sore spot in my upper arm, a spot about a half a foot away. Looking closely at ourselves, with a fresh lens can reveal a great deal.
Parkinson’s Disease agonist medications (Requip and Mirapex) have been shown to cause compulsive behavior for some users. Some users have been shown to be prone to gambling addiction, sex addiction, shopping addiction, food addiction, and gaming addiction may occur. Compulsion may even entice users to go beyond legal limits to feed their desire or lose sense of time.
If you find yourself facing any kind of compulsive behavior that may be taking you away from friends and family, or is disrupting your life, tell your neurologist and someone close to you about breaking the cycle. Communication is so vital to your well-being. Carrying secrets only fuels the tension and stress on the mind and body. Letting go and making a change (with your neurologist’s help) might just be the right move forward.
The Holiday Season means parties, presents, parents, and packing on pounds. It is a special time when family comes together to share the joy and celebration. This time of year can also be difficult and trying for many people due to finances, loss of family members, or just trying to coordinate the added responsibility that comes with this time of year.
The added pressure of trying to produce “the right gift” and to cook “the right meal” on top of dealing with your Parkinson’s disease probably isn’t of benefit to your condition. I know from experience, that when I am overloaded with a laundry list of to-do items and I am facing deadlines, stress and tension builds higher and higher – only to make my PD worsen.
Here are a few suggestions to remind you how to maintain your meds, your mind, and your overall well-being over the holidays:
- Travel can interject a scramble in timing your medications on an irregular schedule and for people with Parkinson’s, timing can be everything. Do your best to sustain as close to your usual schedule as you can to maintain an even stream of your medications. If you need a reminder, use your cell phone or your spouse’s phone to make sure that you don’t miss a dose.
- The Holidays bring on huge changes in our eating habits as we eat and drink more, often of foods that we may not eat at other times of the year. Sweets, pastries, and other rich foods can play a part in reducing your maximum absorption of your medications, so pay attention to what you are eating and how much of it you intake. I find alcohol fiddles with my pills, so I try to not drink at all, but if you do, just pay attention to the impact it may have on what you are taking.
- It can become overwhelming when we have multiple family members from multiple families, kids, animals, music, technology, and food and drink, and loud conversation, all in one room. The energy and space can become overwhelming and feel a little enclosing. We all have different stress triggers that evoke our symptoms to come out more. Be aware what induces certain thoughts and feelings, before the trigger takes hold, if you can. The key is being aware of the situation that you are in at the time.
- Be sure and take time for yourself, when you need it! Everyone at the party and celebration wants you to be at your best and if it means you need to take a little extra time to get ready, ask for a change in food or drink, take a rest, or need to lower the music to be heard better in conversation, I would think that those slight concessions would gladly be made for you.
- Remember to breathe, breathe, breathe! Deep breathing is something very few of us do enough. It feels so good to breath deeply.
- Go into each event expecting to have a good time and to really enjoy yourself. Keep your expectations in check and just be present.
- Stay as active as you normally would on any other day. Keep on your normal health regimen of exercise, sleep, and diet (as best you can) to keep up daily maintenance.
- Address your needs to speak of those you have lost or miss if you can, without interfering with those who may not want to deal with past issues. I like to just light a candle in remembrance of those who are unable t be with us, as this is a way of honoring their memory.
- If stress creeps in and you need something, check out my last blog post on the program, HeadSpace and see if this App does’t help clear some tension and anxiety.
- Lastly, this time of year should be about whatever you want it to be. Placing expectations and conditions on what you hope or think it should be, only weighs you down. If you build up expectations, it can lead to less successful outcomes. Just being as good as you can be at the time of the event, and being yourself, without expectation, may just allow you to find that you enjoy all your events, even more!
Merry Christmas and Happy New Year!