1. PARKINSON’S DISEASE : NUTRITION MATTERS SUSAN BERKOW, PH.D. CNS PRESIDENT SEB ASSOCIATES ADJ PROF GEORGE MASON UNIVERISITY 1211 Tatum Drive Alexandria, VA 22307 susan@susanberkow.com www.susanberkow.com P/F 703 660 6556 susan@susanberkow.com www.susanberkow.com

2. Why is nutrition so important? Swallowing problems Weight loss, loss of appetite Constipation Bone thinning Dehydration Slows stomach emptying and slows gastrointestinal tract – medication Medication interaction

3. Swallowing problems Adequate nutrition Weight loss Taste, smell, texture may be compromised Increased risk for malnutrition Recommended Dietary Allowances (RDA) 1800 Kcal 3 servings each fruits and vegetables 6 servings grain 3 servings dairy Approximately 5 ounces protein

4. Unplanned weight loss Nausea, loss of appetite, depression, slowed movement Can lead to: weakened immune system, muscle wasting, loss of vital nutrients and risk for other diseases Loss of 5-10% of normal adult weight – for example, a 150 pound man loses 15 pounds (10%) he will be at increased risk for illness and (death)

5. Bowel Impaction Slowing of colon Fiber – 25g/day Dry hard feces that are impossible to pass normally

6. Bone Thinning Men and women Malnutrition Increased risk of falls Calcium, magnesium, vit D and vit K Exposure to sunlight Supplements: 1200mg Calcium, 800 IU vit D. Dairy foods, green leafy vegetables, broccoli Weight-bearing exercise

7. Dehydration Medications can raise risk Can lead to confusion, weakness, balance problems, respiratory failure, kidney failure and death. At least 8- 8 ounce glasses water/day

8. Medications Polypharmacy – many medications, some for other conditions Nausea Appetite loss Edema (fluid retention) Compulsive eating and weight gain

9. levodopa Sinemet, Sinemet CR, Madopar, Dopar, Larodopa, Prolopa, Syndopa If you take with meal, may take a long time for need to be absorbed because the stomach takes 1 to 3 hours to empty Fat takes even longer to clear the stomach Protein from the meal is broken down to amino acids in the intestine.. They have to cross across the intestinal wall to get to the blood. Then they have to cross the “blood-brain” barrier to get into the brain. PD meds (levodopa) use the same carrier system as the amino acids – competition May be necessary to take care with timing of meds and protein- containing foods. Preferably at least 60 minutes before or after a meal

10. Nausea Ginger tea Ginger ale Graham crackers Controlled release? So it can be taken with a meal; however it requires more time to become effective – recommend also taking about 60 minutes before meal.

11. Therefore, a meal high in protein combined with Sinemet can seriously interfere with levodopa absorption, particularly at the level of the brain receptors. Research indicates that many people who experience "on-off" fluctua- tions can benefit by adjusting their protein intake.

12. Protein Calculate about ½ gram of protein per pound of body weight. For example is you weigh 150 pounds, that will be about 75 grams of protein per day. Divide it into three meals and two to three small snacks. Try for about 20-25 grams of food for each meal and 5 grams in your snack. DON’T worry about every single gram. It will work out over a week.

13. Amounts of protein in common foods Food Grams Protein (approximate) Bread: 1 slice3 grams Meat,poultry, fish: 1 ounce7 grams Vegetables: 1/2 cup2 grams Fruit: 1/2 cup0 grams Milk: 8 ounces8 grams Yogurt: 8 ounces9 grams Egg: one large6 grams Cheese: 1 ounce7 grams Cooked dried beans, peas Lentils 1 cup 20 grams Peanut butter: 1 tablespoon4 grams Nuts: 4 tablespoons (1 ounce)4 grams