Parkinson’s Disease: Nutritional Considerations

September 25-30th was Parkinson’s Awareness Week, so this month we discuss the nutritional considerations for those living with Parkinson’s disease. Parkinson’s disease is a progressive neurological condition which is characterised by motor (movement) and non-motor symptoms.

Adequate nutrition is vital to maintain health. This is particularly important while living with a chronic progressive condition. Unintentional weight loss is a potential problem in Parkinson’s and may be associated with the following:

• Tremor

• Bradykinesia

• Fatigue

• Dysphagia

• Anosmia

• Fine motor changes

• Nausea

• Medication interactions

• Dyskinesia

Tremor: Tremor, which does not occur in all cases, results in an increased use of kilojoules (energy) which may exceed the daily kilojoules consumed. Therefore it will be necessary to increase intake. If upper limb action tremor is present, it may also impact on the physical act of eating. An increased dietary intake will address the added energy requirement caused by ongoing tremor. A high energy and protein diet or use of nutritional supplements may be beneficial to assist with meeting increased requirements.

Bradykinesia and Fatigue: Bradykinesia (slowness) of the muscles involved in swallowing impacts greatly on eating. For this reason people with Parkinson’s (PWP) frequently reduce the portion size of their meals leading to weight loss.

Fatigue is also a major problem in Parkinson’s disease and will impact on meal preparation and eating. It is compounded by bradykinesia. Consuming smaller, more frequent meals or ‘grazing’ can assist with increasing oral intake and assisting with managing fatigue and slowness at meal times.

Dysphagia: Bradykinesia of swallowing related muscles can lead to delayed swallow and associated risk of aspiration. Refer to the speech pathologist to assess swallowing and the need for modified diet and liquids if residents display swallowing difficulties.

Anosmia: Approximately 90% of people with Parkinson’s will experience loss of sense of smell before motor symptoms of Parkinson’s disease are detected. A decreased sense of smell impacts on taste sensation and will affect appetite and enjoyment of food. This may potentially lead to weight loss. Adding extra spices or flavourings to food, if taste is affected, can help improve palatability and intake.

Fine Motor Changes: Repetitive automatic skills such as chopping, cutting and whisking are frequently affected in Parkinson’s disease. This can impact on meal preparation. Also, the basic skill of hand to mouth action may be affected. These changes can lead to reduced dietary intake. Adapted cutlery and plates may be of benefit if self feeding is affected. A review by an occupational therapist is recommended to assist with implementing strategies.

Nausea: Some medications used to treat Parkinson’s may cause nausea, this can impact intake at meals, putting residents at risk of weight loss. Small regular intake of meals and snacks can be effective. Carbonated beverages such as lemonade and dry ginger ale can also assist with settling nausea.

Medication Interactions: Dietary protein is broken down in the intestine into amino acids. These amino acids must cross the intestinal wall and subsequently the blood brain barrier to access the brain. Levodopa, a common Parkinson’s medication, uses the same carrier system. Therefore, the presence of amino acids from protein may interfere with the absorption of Levodopa. This does not affect all people with Parkinson’s disease, yet those who experience ‘on/off’ fluctuations may benefit from adjusting protein intake times.

Dyskinesia: Dyskinesia is the term given to involuntary movements which may result from extended use of Levodopa. These movements can range from slight to severe. They will increase metabolism and may result in weight loss. An increased dietary intake will meet the increased kilojoule demands. Fortifying foods with extra energy and protein or supplementing intake with nutritional supplements can assist increasing energy intake and avoiding weight loss.

Constipation is another common complication of Parkinson’s disease. Nerve degeneration can slow bowel muscles. Nutritional interventions can assist such as adding extra fibre to the resident’s diet, and encouraging fluid intake. Dietary fibre is indigestible, so it adds bulk to our bowel motions and prevents constipation. However, if a person with Parkinson’s disease finds it difficult to chew or swallow, they may have trouble eating fibrous foods. Trial easy-to-eat fibrous foods such as soft fruits or consider mashing or pureeing fruits to make them easier to eat. Adding bran or psyllium husk to cereals at breakfast is also another simple strategy that can help increase resident’s fibre intake.

As you can see, many symptoms of Parkinson’s disease can greatly impact nutritional intake and those suffering from the disease have a high risk of malnutrition. Weight loss is associated with poorer outcomes, and loss of muscle mass may contribute to poor muscular control and incidence of falling. It is important to monitor oral intake, regularly screen and weigh patients, and monitor for worsening symptoms that may affect nutritional status (i.e. dysphagia, fine motor skills, worsening dyskinesia).