Dan Keller
Welcome to episode four of Substantial Matters, Life and Science of Parkinson's. I'm your host, Dan Keller. At the Parkinson's Foundation, we want all people with Parkinson's and their families to get the care and support they need. Better care starts with better research and leads to better lives. In this podcast series, we highlight the fruits of that research, the treatments and techniques that can help you live a better life now, as well as research that can bring a better tomorrow. Today, we're continuing our conversation with Professor Bas Bloem, a movement disorder neurologist at the Radboud University Medical Center in Nijmegen, the Netherlands, a Parkinson's Foundation Center of Excellence. We're talking about an aspect of Parkinson's that, up to now, hasn't received much attention, nutrition. Dr Bloom says that people with Parkinson's often face problems getting adequate nutrition. He offers tips on how diet can help improve some of the symptoms of Parkinson's and optimize the effects of medication. We spoke at the World Parkinson's Congress last September.
Dan Keller
What have you been looking at in nutrition?
Dr Bloom
I think nutrition and Parkinson's is an important new kid on the block. I think 10 years ago, nobody talked about it. We now know that there are a number of issues. First, malnutrition is very common in people with Parkinson's disease. Losing weight is very common. There are issues related to interference of protein rich meals with the levodopa absorption. And then, of course, there is the big question from patients, could nutrition slow down the progression of the disease? So there are a number of issues related to food and Parkinson's.
Dan Keller
And what sort of things have you found, or do you even have recommendations at this point?
Dr Bloom
My own research has shown that, for example, weight loss is really common and malnutrition is really common. That's now supported by research from many other groups in the field. There are a couple of important recommendations for people out there. A key one is to avoid levodopa intake with proteins. Levodopa itself is an amino acid, and proteins are degraded into amino acids, and they start competition in your intestines for absorption. So it's best to take your levodopa an hour before or an hour after your meal, or to take it with, for example, sparkling mineral water, which really helps to absorb the medication better. So that's one important thing. The other thing is there are certain elements of the diet that appear to be bad for people with Parkinson's. Dairy products appear not to be so good, particularly in the phase before you develop Parkinson's, whereas a Mediterranean diet, olive oil, lots of fish, lots of vegetables, or even a vegan diet is good for people with Parkinson's.
Dan Keller
Is appetite a problem or taste? Because one of the early signs is loss of the sense of smell, and so much of taste has to do with olfaction.
Dr Bloom
Absolutely. So that's another issue. The loss of smell makes people lose their appetite. I'm actually proud to say that in Holland we've just published a cookbook for people with Parkinson's. It's now in Dutch, but we're in the process of translating it into English, and it has a series of recipes that are particularly tasty for people with Parkinson's so that they regain their appetite. Another element is the constipation, the lazy bowel movements. Some people actually stop eating because they fear the stomach aches which they experience after eating when they have constipation. So another big issue for Parkinson's is to aggressively treat that constipation, lots of fluid intake, ideally two liters, sorry for the European units, fluid a day. That's difficult, but you have to engage in that routine a day. The regular exercise that we talked about earlier is also good for the constipation, because the constipation interferes with the absorption of medication in the intestine. So if you have bad constipation, your drugs are much less likely to work.
Dan Keller
Well, for people who don't have the cookbook, and hopefully it will reach us in English, what kind of things are elements of the recipes? Do they depend on taste sensation in the tongue, sour, sweet, bitter, or salty, that kind of thing?
Dr Bloom
It's a couple of things. So what the cookbook does, and I'm actually excited about this, we published a guideline in Dutch on nutrition issues for people with Parkinson's. The problem with guidelines is nobody reads it. So the cookbook is a series of tasteful recipes intermingled with advice from the guideline, so it's a way of cleverly implementing the guideline. And the number of issues that we address is how to prepare a meal. If you have loss of dexterity because of your Parkinson's, it's more difficult to prepare the meal, so the recipes are easy to prepare. There's the issue of taste, so they're particularly tasty, more spicy, so that you can raise your appetite. There's the element of the proteins, so they tend to be low in proteins and high in vegetables. And of course, eating should be fun and tasty, so and it looks nice.
Dan Keller
I saw here at the World Parkinson's Congress a vendor was selling a device which dampened tremors so that the peas stayed on the spoon. That sort of thing, is even getting the food a problem?
Dr Bloom
Yeah, for some people, it can be a problem. We've also worked with the spoon. The interesting thing is it worked for some people, and then it works terrific. For others it didn't work, and in a few people it made things worse. So I think the anti tremor spoons that are out there are for hope, but not for all folks, and I think the algorithms still need to be refined a little bit more.
Dan Keller
Are there other devices or techniques which would help people eat so they get good nutrition?
Dr Bloom
Well, one of the tricks that one of my patients taught me, I try to listen to my patients, they have the richest experience. We talked about the fluid intake, two liters per day. One of my patients does is he takes two empty Coca Cola bottles, could be any other brand, and fills it with water and puts it on a visible place in his house, and at the end of the day the bottles need to be empty. That's a simple trick that I can recommend to all the people, because it improves your bowel movements, makes the medication work better.
Dan Keller
What about high fiber? Cereals, fruits, vegetables?
Dr Bloom
High fiber is also very important. Cereals are important. So in general, I think people with Parkinson's should be aware that they should try to avoid peaks in high protein. So don't take a big stake all at once, but try to divide the protein over the day. Don't avoid protein altogether, because weight loss is another issue in people with Parkinson's disease, and losing a bit of weight is okay, because the less pounds you have to carry around the better it is. But there comes a point where malnutrition really kicks in, so spread the proteins over the day, high fibers, and if possible a Mediterranean diet.
Dan Keller
Anything to add that we've missed or is interesting?
Dr Bloom
Well, the final element is that perhaps nutrition and dietary issues could slow down the progression of the disease. Again, like exercise, extremely difficult to prove. There is interesting work in, again, rodents that dark fruit, for example, contains high levels of antioxidants, which could be interesting. That's work in progress. The good news for people in the field is there's lots of research going on, so keep an eye open for work done also by the MPF about new news in this field.
Dan Keller
It sounds like fruits and vegetables with a lot of color are the way to go.
Dr Bloom
Yeah, exactly. So dark fruit, berries, strawberries, that's the type of stuff that contains high levels of antioxidants. And I tell you, even if the research is still a little bit weak, I would recommend regular use of it.
Dan Keller
I appreciate it. Thank you.
Dan Keller
There are many things you can do to live well with Parkinson's, and as Dr Bloom described, the choices you make about food, what you eat and drink, how much and when, have an impact on your health and well being. To find out more about nutrition and diet, call our helpline at 1 800 4PD info, and if you want to leave feedback or comments on this podcast or any other subject, you can do it at parkinson.org/feedback. We'll respond to some questions in future episodes. At the Parkinson's Foundation, our mission is to help every person diagnosed with Parkinson's live the best possible life today. To that end, we'll be bringing you a new episode in this podcast series twice a month. Till then, for more information and resources, visit parkinson.org or call our toll free helpline at 1 800 4PD info, that's 1-800-473-4636. Thank you for listening.
