Maintaining a healthy weight
Parkinson’s may lead to gain weight due to reduced mobility. Being overweight can strain the joints which can in turn make moving around more difficult. If this happens you may be advised to watch your diet and control the calories you consume, for example by avoiding fried foods, sweet desserts, cakes and biscuits and sugary drinks.
More commonly, people with Parkinson’s lose weight. If you lose weight this may be due to a number of factors; loss of appetite, difficulty eating or swallowing, nausea, using extra energy to cope with symptoms such as dyskinesia or your body may not absorb nutrients efficiently. Various medications may also affect your body weight.
The following suggestions may help increase your calorie intake:
- Try eating four or five small but appetising meals a day, with a snack between each meal.
- Incorporate a little more butter, cream, peanut butter, milkshakes, biscuits, chocolate and dessert, but make sure you take good care of your teeth if you eat a lot of sugary food!
- Add three or four tablespoons of milk powder to half a litre of full cream milk to make it more nutritious.
- Try nutritious drinks specially formulated to easily increase calorie intake.
- Eat food that you like as you are likely to consume more.
- If you find cutlery difficult to use, try to have some meals that you can manage with your fingers or using only a spoon.
Oral nutrition supplements (ONS) are available either from pharmacies or on prescription and may help if you still struggle to maintain a healthy weight. ONS are multi-nutrient liquid, semi-solid or powder products that provide macronutrients and micronutrients (vitamins and minerals) with the aim of increasing your oral nutritional intake. Your doctor or a dietitian will be able to advise on such supplements. A dietitian can also advise how to prepare your own ‘food first’ supplements if you prefer.
It is a good idea to weigh yourself regularly and record your weight over a period of time. This can provide useful information for your doctor or a dietitian if needed.
Getting the right balance
A balanced daily diet will contain a wide variety of foods from the five food groups listed below. Ideally you should eat food from at least three different groups at each meal, making sure that you cover all groups throughout the day. This may not be possible if you take certain medications so always follow any instructions you are given regarding medication and diet.
General dietary recommendations currently include:
- maintaining energy intake at 25-30 kilocalories per kilogram of body weight, with additional calories if you experience dyskinesia
- a carbohydrate to protein proportion of at least 4-5:1
- a recommended daily protein allowance of 0.8g/kg of body weight.
Five food groups
Carbohydrates are starchy and/or sugary foods which provide the basic fuel or energy your body needs since they produce glucose once digested. Typical carbohydrates are bread, potatoes, pasta, rice, cereals, biscuits and cakes.
If you have had Parkinson’s for a long time you may find that foods rich in carbohydrate and sugar worsen dyskinesia. However it is important not to exclude carbohydrates from your diet as they are important in maintaining body weight and energy levels. As with all nutrients, you need to find a sensible balance.
Meat, Fish, Eggs, Beans and other non-dairy sources of Protein
Proteins are the basic building blocks your body needs for growth and repair. Typical proteins are meat, dairy products, nuts, pulses, eggs and fish. Vegan alternatives are also available.
Milk and Dairy Products
Dairy foods provide all three macronutrients: carbohydrate, protein and fat. They also contain micronutrients such as vitamin and minerals, making dairy products an important food source in your daily diet. If you choose not to eat dairy products, you must ensure you are getting sufficient calcium and other nutrients buy consuming other non-dairy sources of these nutrients.
Observational data suggests a possible link of a high intake of animal fat and a high dairy product consumption and the development of Parkinson’s, particularly in men. However, more studies are needed to further examine these findings and to explore underlying mechanisms for the association.
Fruit and vegetables
These are a good source of fibre and are essential for healthy bowels and avoiding constipation. They also contain some carbohydrate together with many vitamins and minerals. Fruit and vegetables can be eaten fresh, frozen, canned or dried. A high intake of unsaturated fatty acids and a plant-based dietary pattern (consisting of high intakes of fruit, vegetables, legumes, whole grains and nuts) plus fish, which is low in saturated fat, may protect against Parkinson’s.
Fats and sugars
Although fats and sugars can be harmful if consumed in large quantities, they are essential for producing energy so should be eaten in moderation. ‘Essential fatty acids’ are also needed for the efficient absorption of some key vitamins in your body.
In addition, you need to consider fluids and micronutrients (vitamins and minerals):
It is important to drink plenty of fluids, preferably 8 to 10 cups daily. Carbonated or fizzy drinks may make you feel bloated so may be best avoided. Unless your doctor has advised you not to drink alcohol, this can be consumed in moderation.
If you have problems with your bladder and need the toilet frequently at night you may find it better to drink mainly in the morning and early part of the day. If your mouth is often dry, frequent sips of water or using an oral rinse or spray can help. Sucking a sweet or chewing gum can also stimulate the production of saliva which can alleviate dry mouth.
As we age our natural thirst reduces and as some Parkinson’s medication can dehydrate the body, it is really important to drink regularly, if necessary at timed intervals during the day. Food is far also more easily eaten and digested with fluids.
Constipation is a common problem in Parkinson’s and altering your diet may be a key factor in managing this. Gradually increasing your intake of fibre rich foods such as fruit, vegetables, pulses, lentils, wholegrain breads and cereals can help. Be aware that too much fibre can actually cause constipation, so you do need to get the balance of fibre and fluid right. Choosing and eating complex carbohydrates found in wholegrain foods, fruits and vegetables is more likely to help with constipation than eating processed food and sugars.
Increasing your fluid intake can help as fluid is absorbed by the bowel to soften stools and make them easier to pass. Exercise is also beneficial as this helps to stimulate the bowels.
If constipation is not relieved by altering your diet and increasing your activity level, then it is best to speak with your doctor or other members of your care team
See also Bowel problems.
Calcium and Vitamin D intake
Osteoporosis (brittle bones) is particularly important to avoid as falls are common in Parkinson’s. It is now thought that there is a link between the severity of Parkinson’s and bone density so you should ask your doctor to assess your calcium and Vitamin D to reduce the risk of osteoporosis. To keep your bones strong, aim for at least 1200 mg of calcium and 600 IU of vitamin D per day (800 IU of vitamin D per day if you are over the age of 70). This can be met through a combination of foods, beverages and supplements.
- Good food and beverage sources of calcium are low fat milk, fortified soy/rice beverages, fortified juice, low fat cheeses and yogurts.
- Good food and beverage sources of vitamin D are low fat milk, fortified soy/rice beverages, fortified juice, fatty fish, and fortified yogurt.
- There are many different kinds of calcium and vitamin D supplements. Ask your pharmacist for advice on the different kinds available. If you unable to move around, do not take calcium or vitamin D supplements without consulting your doctor.
Do as much weight-bearing exercise as you can, such as walking, dancing, or aerobics. Aim for 30 minutes or more of activity per day as often as you can. Talk to your doctor or physiotherapist on how to safely include activity into your lifestyle.
Other vitamins and minerals
By eating a variety of foods from the various food groups you should get all the vitamins and minerals your body needs. If you are deficient in any particular vitamin or mineral it is generally better to increase your intake of foods containing the particular nutrient rather than a supplement, although sometimes a supplement may be the only answer, particularly if your body does not absorb nutrients well.
Vitamins A, D, E and K tend to be found in milk and dairy food and are fat-soluble, which means that they remain in the body for some weeks before being used or expelled.
Vitamin B levels are often found to be low in some people with Parkinson’s so it is thought that good levels of vitamin B6 may reduce the risk of developing the condition. Vitamin B12 is also important in healthy brain function so maintaining good levels may reduce the risk of cognitive problems.
Vitamins B (complex) and C are mostly found in citrus fruit and green, leafy vegetables and need to be consumed daily as they are water-soluble and therefore do not remain in the body for any period of time.
Minerals are present in many foods although often only in very small, or trace, quantities. Key minerals include calcium, chloride, chromium, fluoride, iodine, iron, magnesium, manganese, phosphorous, potassium, selenium, sodium, sulphur and zinc.
It is best to speak to your doctor or pharmacist if you are concerned or considering taking any supplements as some can interfere with the way prescribed medications work. Do not take excessive doses of supplements as these can cause other health problems.
Certain vitamins and minerals are known as antioxidants as they can help reduce the damage caused by free radicals (damaging molecules produced by normal chemical reactions in your body or absorbed from outside sources such as pollution, cigarette smoke or excessive sun). Although free radicals last for only a short time in the body, they can be very harmful. Antioxidants limit cell damage by trapping and neutralising free radicals.
Vitamin E, an antioxidant, was thought to slow the progression of Parkinson’s but research has yet to confirm this theory. Food sources, which have been shown to be protective include plant oils (soya, corn and olive oil), nuts, seeds and wheat germ (found in cereals and cereal products). Vitamin E supplements appear to offer no benefit in delaying the progression or improving motor function of people with Parkinson’s.
There is no evidence at present to suggest that antioxidants will slow the progression of Parkinson’s. Providing you are eating a balanced and healthy diet you are unlikely to need to take antioxidant supplements but if you have any concerns do ask your doctor or dietitian. Taking excessive amounts of antioxidant supplements can in fact be harmful to your health and may interfere with your Parkinson’s medications.
Brightly coloured foods generally have good levels of antioxidants, for example berries, yellow and dark leafy greens. Green tea, red wine and chocolate also contain antioxidants.
Co-enzyme Q10 has strong antioxidant properties but studies do not suggest that it is an effective Parkinson’s treatment. You should talk to your doctor if you are considering taking extra co-enzyme Q10. This can be found in small amounts in a number of foods such as oily fish, offal and beef.
Caffeine intake has been associated with decreased PD risk, particularly in men. However, it is premature to recommend increasing caffeine consumption to prevent PD, particularly in women taking oestrogen as an increased risk of Parkinson’s has been observed in post-menopausal estrogen users with a high caffeine intake.
Special diets for Parkinson’s
Certain foods, vitamins or special diets are sometimes recommended as being beneficial if you have Parkinson's. You should always discuss any special food or diet with your doctor as there is generally no scientific evidence to support these.
Broad beans (fava beans) are reputed to help Parkinson's symptoms as they contain levodopa but unfortunately this is in such small and variable amounts that they cannot be effective. The quantity that would necessary in order to obtain an effective amount of levodopa would probably cause illness or other side effects.
You should always discuss with your doctor, or Parkinson’s nurse if you have one, when to take your medications. Most medications can be taken at any time and do not need to be specially timed in relation to meals. You may find sipping a drink makes it easier to swallow your tablets but avoid milk, a protein, when taking levodopa.
Levodopa and protein
Adequate protein intake is necessary to maintain optimal health. For most people with Parkinson’s, the timing of protein intake plays no role in levodopa effectiveness. A low-protein diet is not recommended for individuals on levodopa, nor is a protein-redistribution diet recommended for people with Parkinson’s who do not respond to levodopa therapy.
Discuss options with your doctor and you may need to experiment with timings and quantities of protein to see what works for you. Whatever you decide, do not cut down on the amount of protein you eat as it is vital for the body to renew itself, to fight infection and to maintain a healthy weight.
Antacid or indigestion tablets should not be taken at the same time as Parkinson's medications as they can interfere with absorption of the medicine. They can however generally be safely taken at a different time to your medications. Your doctor, Parkinson’s nurse or pharmacist will be able to advise.
Managing symptoms with nutrition
- Eat foods high in fibre, such as wholegrain breads or bran cereals, fruits (including prunes) and vegetables, also legumes such as beans, peas and lentils.
- Increase your fluids (aim for 1.5 – 2L each day) to make sure your fibre intake works well.
- Try to be physically active each day.
Poor appetite, nausea and vomiting
- Have small frequent meals.
- Take medications with a small meal or snack (such as juice, a cracker, cookie or fruit).
- Drink some ginger ale; it may help to reduce nausea.
Heartburn, reflux and bloating
- Have small frequent meals.
- Limit or avoid alcohol, caffeine and carbonated drinks.
- Sit upright at meals and for 45-60 minutes after eating.
- Limit or avoid foods that may trigger symptoms such as spices, peppermint, chocolate, citrus juices, onions, garlic and tomatoes.
- Avoid using straws and sucking on hard candy to reduce gas and bloating.
Problems swallowing food or thin fluids
- See your doctor if you have problems swallowing foods or liquids. You may need a swallowing assessment.
- Ask your doctor to refer you to a dietitian. The dietitian can suggest some ways to modify the foods you eat and the fluids you drink so that they are right for you.
Problems moving jaw, lips, tongue
- Eat soft foods, like cooked cereals, soft scrambled eggs, gravies, sauces, thick soups, ground meats or soft casseroles.
- Try mincing your foods.
Slow or uncontrolled movements
- Do not skip meals.
- Allow enough time to eat.
- Have small portions and pre-cut foods or finger foods.
- Eat in a quiet setting.
Orthostatic (postural) hypotension
- Avoid large meals.
- Reduce carbohydrate intake, especially single sugars.
- Increase intake of salt.
- Increase fluid intake.
- Decrease or omit alcohol intake.
All too often the effort involved in preparing food can mean you don’t have the energy or inclination to eat properly so the following practical tips may be helpful.
Shopping and preparing meals
Careful planning can make shopping and preparing meals far easier. Keep a good range of foods in your cupboard and freezer that have a long shelf life as these are always a good back up if you are unable to shop as planned.
- Plan meals in advance and write a list of the ingredients before going to the shops, or ask someone to buy ingredients for you.
- Think about how long you can stand preparing your meal and don’t decide on a menu that will take longer to prepare than you can cope with.
- If taking the trouble to cook a meal that can be frozen for other days then remember to double or treble the quantity so that you have a few quick and easy meals another time.
- Make use of ready prepared meals as they can be simply reheated and can save on electricity or gas as well as your own energy. Remember that frozen and tinned vegetables and fruit can be just as nutritious as fresh.
- If you like a sleep during the day, take a flask with you so you can have a hot drink when you wake up without going to the kitchen.
- If you do not own a microwave consider buying a small one as meals or snacks can be very simply and quickly cooked or reheated this way.
Special food aids
Special aids for eating are available. Ask your occupational therapist for information on what is available in your country to suit your needs. Below are some suggestions that may help although not all may be available where you live:
- Try using cutlery that has specially adapted handles which are angled or weighted for ease of use, or ‘rocking’ knives that can be used one handed.
- Try using two handled cups or beakers, or a large mug filled only halfway to reduce spillage.
- Use an insulated cup to keep hot drinks warm.
- Uuse specially weighted cups that help prevent tremor.
- Use a straw and don’t overfill cups.
- Use an apron or bib and an easy wipe table cloth.
- Try placing elbows on the table to steady your hands and arm when eating.
- Try raising your plate on a book or box so that it is nearer to your mouth.
- Use a damp cloth or special non-slip mat under a plate can stop it moving as you eat.
- Try using a special plate which keeps food warm or microwave a meal when it becomes cold so that it remains appetising. Some plates have angled, high rims to prevent spillage and make it easier to get food onto cutlery.
- Cook for special devices designed to grip jars and bottles for easy opening.
- contact your local Parkinson's disease organisation for information on aids that are available in your country
Eating and swallowing
Being comfortable when eating is important. This will allow you to eat and swallow more easily.
If a meal takes a long time and becomes cold and unappetising you may prefer to eat smaller portions and four or five smaller meals rather than three large meals each day. It is also a good idea to time meals so that medication is working properly so try to avoid eating meals when you are ‘off’.
If you have considerable difficulty swallowing or opening your mouth ask to see a speech and language therapist. They will be able to check if anything else is causing your problems. They can then give you tips on the consistency and texture of food to make it easier to eat, and also on different ways of eating.
Some tips for easier swallowing are:
- Try to relax the throat muscles by yawning before and during eating.
- Find a comfortable position and sit up straight without leaning on the table.
- Try tucking your chin down to your chest to make swallowing easier.
- Soften hard foods with sauce, gravy, or dips.
- Avoid soups with bits in and go for thick creamy ones rather than thin, watery soups.
- Take smaller mouthfuls and regular sips of water.
- Avoid dry, brittle foods such as toast or crackers, or if you really like to eat these moisten them with plenty of spread or dip in something like soup.
- Eat wholemeal bread rather than white as it is less likely to get stuck around your mouth.
- Instead of bread try pasta, noodles or mashed potato as carbohydrate in a meal.
- Ensure that any dentures are a good fit and not uncomfortable when chewing.
A semi-solid diet will make swallowing much easier. In extreme cases a puree diet may be recommended but you should only follow such a diet on the advice of your doctor, dietician or speech and language therapist.
Below is a sample of a daily eating plan with regular meals which include a wide and balanced range of foods from the various food groups.
These suggestions are for guidance only and there are of course other options and alternatives available.
Fruit or fruit juice; cereal (wholegrain if constipation is a problem) with milk; bread or toast with butter or margarine and jam or other spread; bacon, sausage, egg, cheese, cold meats etc
Meat, fish, eggs, cheese, pulses, lentils or other protein; potato, rice, pasta, noodles, bread or other carbohydrate; vegetables or salad; yoghurt, milk pudding or fruit drink
As midday meal
Snacks between meals
Fruit, cakes, biscuits, sandwiches and cereals
You should drink with meals and between them too, for example tea, coffee, fruit juice, water, milk, soup. Beware of drinking too many carbonated drinks as they may make you feel bloated and unable to finish your snack or meal.