Parkison’s disease and nutrition

Parkinson's disease is a progressive, degenerative neurological disease. It is due to the degeneration and death of neurons in an area of ​​the brain known as the substantia nigra, which causes a decrease in a substance called dopamine, essential for movements to be carried out in an agile, effective and harmonious way. In Parkinson's disease, the population of these neurons decreases by more than 80%. The cause of the degeneration of neurons is unknown.

 

Parkinson's disease must be differentiated from other processes called parkinsonisms or parkinsonian syndromes, which are disorders that show signs and symptoms of Parkinson's disease but are secondary to an identifiable cause and are resistant to treatments that do work in the disease. Parkinson's. Parkinson's disease would be a primary parkinsonism or of unknown cause. Among the causes of "secondary" parkinsonism are neurodegenerative processes such as Alzheimer's disease, Huntington's disease (in its rigid variant), progressive supranuclear palsy, or olivopontocerebellar atrophy; cerebral vascular accidents; repeated trauma (such as in boxing causing so-called "boxing encephalopathy"); certain infectious processes (including diseases caused by prions); after vaccinations; you take medications such as haloperidol or metoclopramide; or by certain metabolic disorders such as Wilson's disease, acquired hepatocerebral degeneration, hypoparathyroidism, and pseudohypoparathyroidism. We will refer to Parkinson's disease, although many concepts to which we will refer are valid for any form of parkinsonism.

 

Parkinson's disease is a common disease that usually begins between 40 and 70 years of age. However, it can also debut before the age of 40.

 

It has been said that saturated fat (fat of animal origin) could increase the risk of suffering from the disease, while a diet that follows the Mediterranean diet pattern, that is, with abundant fruits and vegetables, rich in legumes, cereals and fruits dried and with fish as a source of protein and fat, the incidence of this disease would decrease. Similarly, the intake of vitamin B6 at high doses could be protective against the presentation of the disease.

 

The main symptoms of Parkinson's disease and present in most patients are tremor at rest (which usually disappears during voluntary movements), muscle stiffness, slowness and low amplitude of voluntary movements, balance disorders postural (which generate gait disturbances and falls to the ground), and the characteristic gait (it is a gait with short, rapid steps in an uncontrolled manner called a "festive gait"). Other symptoms may appear such as speech problems or dysphonia, impaired handwriting, difficulty swallowing (dysphagia), lack of facial expression (blank face, which has been called poker player facies or mask facies), symptoms autonomic (postural hypotension, urinary urgency, sweating), seborrhea, pain and other sensory symptoms, fatigue, cognitive dysfunction and dementia, depression, sleep disorders, sexual problems and constipation.

 

Without treatment, Parkinson's disease progresses within 5 to 10 years to a state where the person is stiff and practically motionless, with intense tremor, and where the patient is unable to fend for himself and is confined to a chair. wheels or immobilized in bed. Death usually occurs from complications of immobility, including aspiration pneumonia or pulmonary embolism. The availability of effective drug treatment has radically changed the prognosis of Parkinson's disease; In most cases, good functional mobility can be preserved for many years, and the life expectancy of properly treated patients is substantially increased.

 

Parkinson's disease and parkinsonism in general produce negative alterations in the nutritional status of the patient, which are what we will be able to modify and treat. Let's review them briefly.

 

Malnutrition and weight loss: These are usually due to several causes:

 

• Inability of the patient to carry out coordinated movements, as well as the trembling of the hands, which makes them incapable or makes it difficult for them to use the cutlery correctly.
• Alterations in salivation (drooling) and chewing.
• Loss of appetite secondary to the hypothalamus alterations typical of the disease.
• Associated depression, which will also contribute to the refusal to take food.
• Constipation.
• Dysphagia (difficulty swallowing food), which appears in advanced stages.

At times, the drugs used to treat the disease can cause adverse effects such as loss of appetite, reduced olfactory sensitivity, nausea, constipation, etc., which make it difficult to eat food.

 

Possible increase in energy expenditure: Tremors at rest are a characteristic of the disease, which could increase energy expenditure in these patients; however, the limitation of mobility compensates for the expenditure and the majority of patients do not present an increased total energy expenditure.

 

Other aspects to consider refer to the digestive system, with the formation of fecalomas, which make defecation difficult.

 

Once nutritional problems have been identified, we will act accordingly. Together with pharmacological treatment, based on the administration of levodopa, it is possible to help these patients to achieve correct nutrition. Here are some practical solutions to avoid malnutrition, weight loss, and the risk of injury or complications in patients with parkinsonism:

Aspects related to nutrition:

• Eat frequent and small meals (for example, 5 or 6 meals a day).
• Use the maximum variety of foods.
• Choose foods according to the patient's preferences.
• Take care of the presentation of the dishes. They should be dishes that attract the attention of the patient, with a wide range of colors and shapes, and not repeat them.
• Food should be smooth and homogeneous textures.

Ensure a high intake of proteins, both of animal and vegetable origin. They are found in meat, fish, eggs, milk, legumes. However, we must consider the interaction of levodopa, a drug used in the treatment of Parkinson's disease, with foods rich in protein (see later in the text).

 

Give blue fish, which are rich in polyunsaturated fat.

 

Carbohydrates are a good source of energy, but you have to avoid consuming excess simple sugars.

 

Fats improve the taste of food and are a vehicle for fat-soluble vitamins and essential fatty acids. We must increase the contribution of unsaturated and polyunsaturated (olive, sunflower, soybean, fish, etc.) and decrease the saturated (animal fats, etc.).

 

The contribution of vitamins and minerals is achieved with the inclusion in the diet of vegetables, fruits and fresh vegetables.

 

The consumption of vitamin B6 (pyridoxine) should be limited in patients receiving levodopa since this vitamin reduces the absorption of the drug; If the patient takes a multivitamin preparation, it is convenient to check its content in this vitamin.

 

Ensure the intake of at least one and a half liters of water and fluids a day, even if the patient does not feel thirsty; in case of difficulty swallowing use thickeners.

 

The intake of foods rich in fiber promotes intestinal activity and prevents constipation. We find it in vegetables, fruits and whole grains.

 

Increase the intake of foods rich in fiber to promote intestinal activity and avoid constipation. Fiber is found in vegetables, fruits, legumes, and whole grains. It will be accompanied by a greater intake of fluids (4 to 6 glasses of water a day).

 

Avoid astringent foods (rice, chocolate, etc.).

 

In case of constipation: it is useful to take 2 or 3 plums on an empty stomach, an infusion of flax seeds or a yogurt with crushed plums before breakfast or a fiber supplement.

 

Avoid cheeses with a doughy and / or hard consistency.

 

Avoid fibrous meats that are difficult to chew.

 

Avoid whole nuts.

 

Avoid sweets that stick to the palate.

 

Remove the bones from the fish.

 

Prepare foods that the patient can eat with their hands, without the need for utensils, such as croquettes, meatballs or squid a la romana.

 

Avoid alcoholic beverages, trying to drink water, natural fruit juices and herbal teas.

Ensure dairy intake for its high protein content and rich in calcium and vitamin D (important to prevent bone fractures).

 

Follow a regular meal schedule.

 

Eat sitting at the table and in a quiet environment to avoid distractions.

 

Eat slowly and chew your food well.

 

Avoid distractions during meals such as the television, children playing in the same room, phone calls, etc.

 

Food must always be at an adequate temperature since in advanced stages of the disease, the patient does not distinguish between hot and cold and is highly exposed to injury.

 

If the patient is at risk of injury, use plastic utensils (glasses, plates, cutlery) that do not break.

 

To avoid the spillage of liquids (soup, consommé, ...) from the spoon due to the uncontrolled movement of the hand, you can use thickeners sold in pharmacies, gelatins or corn flour.

Treat swallowing difficulty (dysphagia) when it occurs:

 

Cut into small pieces or shred the food.

 

Use thickeners with liquids. Pharmaceutical thickeners, gelatins, or cornmeal can be used.

 

Administer foods in pureed or porridge texture.

 

Soften solid foods by adding liquids (milk, broth, sauces) to achieve smooth textures.

 

Modify the way you eat: eat small amounts of food at one time, chew well and slowly, and allow enough time for swallowing; do not add food in the mouth, without having swallowed the above.

 

Avoid dry and sticky foods and those that spread through the mouth, such as cookies.

 

Do not speak while eating or drinking.

 

The diet will be adapted if the patient has other pathologies (diabetes mellitus, high blood pressure, increased cholesterol).

Aspects related to drug-food interactions:

Levodopa is one of the best drugs for treating Parkinson's disease. However, we must take into account the interactions that this drug has with food. Some amino acids that make up dietary proteins can make it harder for the drug to be absorbed. Likewise, the effect of levodopa can also be altered in the brain if there are large concentrations of these amino acids in the blood (due to a high protein intake in the diet). All this conditions a loss of the efficacy of the treatment. Thus, it is advisable to take the drug in advance of the meal (30-60 minutes before the meal). This is usually enough without the obligation to eat a restrictive protein diet, which is not recommended. If the drug is poorly tolerated on an empty stomach, it will be administered together with some food with a very low protein content, for example, some biscottes with water or with ginger tea.

 

Remember also that vitamin B6 can hinder the absorption of levodopa, but following the above recommendations the problem is avoided.

Aspects not related to nutrition:

Adapt the house by eliminating obstacles and adapting it as the patient's disability evolves.

 

Try to maintain some social activities with friends, neighbors, family, etc. to distract yourself and feel accompanied.

 

Go for a daily walk in quiet hours and familiar places.

 

Bathing is a good time to check the condition of the skin, nails, and areas most at risk of ulceration.

 

Simplify dressing and grooming by using easy-to-fasten and slip-on clothes and shoes.

 

Night rest is important, so a routine of schedules, environment, etc. must be established. If necessary, pharmacological help can be requested.

 

Carry out health education for the patient, family and / or caregiver, to promote self-feeding and care for artificial nutrition (if necessary), in all stages of the disease.

 

Moral support from the healthcare professional and family can be important to recovery.

 

It is important that families participate in family associations, in order to cope with the disease in a better way.

 

Other treatments in patients with Parkinson's disease include physical therapy, to improve activity and preserve mobility; logotherapy, which improves and preserves language and swallowing. Psychiatric care is needed in many patients to treat anxiety, depression, and psychiatric complications of treatment.