A Healthier You, One Step at a Time

Tag: nutrition

Nutrition & protein intake for Parkinsons

Registered Dietitians are fortunate to have a wealth of scientific data from which to draw reliable recommendations. Recently the recommendation for protein has been updated, this has been a subject that I have debated with a variety of patients that I’ve seen with Parkinsons disease.

I will quote:

A 2010 review found that on average, protein redistribution diets resulted in improved motor function in people who responded to levodopa, although the acceptability of the diet decreased over the long term (i.e. >1 month). The most frequently reported complications of the diet included severe dyskinesias (due to reduced levodopa dose), weight loss and hunger before the evening meal. Occasional complications included psychiatric disorders and hallucinations (due to levodopa overdose).

1. Cereda E, Barichella M, Pedrolli C, Pezzoli G. Low-protein and protein-redistribution diets for Parkinson’s disease patients with motor fluctuations: A systematic review. Mov Disord. 2010 Jul 28. [Epub ahead of print]. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/20669318

A 2017 narrative review noted two large observational studies. One study found that the prevalence of protein-levodopa interaction in those taking levodopa was about 12.4%. The other study suggested that a protein-restricted diet may improve motor function in some people taking levodopa, and that those eating more than 10 g protein/day above the RDA may need a higher levodopa dosage than those eating less protein

2 .Xiong N, Huang J, Guo S, Liu L, Han C, et al. Protein-restricted diets for ameliorating motor fluctuations in Parkinson’s disease. Front Aging Neurosci. 2017 Jun 28;9:206. doi: 10.3389/fnagi.2017.00206. eCollection 2017. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/28701947

In 2019, the 2012 Canadian guidelines for Parkinson disease were updated by an expert panel led by Parkinson Canada (9) and they adopted a NICE guidelines:

People with PD should be advised to avoid a reduction in their total daily consumption of protein” and “discussion should take place about a diet in which most of the protein is eaten in the final main meal of the day (a protein redistribution diet) for people with PD on levodopa who experience motor fluctuations.

3. Parkinson’s disease in adults. NICE guideline [NG71}. 2017 Jul. Available from: nice.org.uk/guidance/ng71

Its important for patients with Parkinson’s consume adequate protein. Patients who are taking their levodopa medication 30 minutes before a meal and do not experience relief can trial a protein redistribution for 2 weeks and if they do not experience relief, discontinue the diet. As well, when a patient experiences relief, they need to make sure their overall protein intake is adequate or they may need to increase the levodopa dosage to manage symptoms and maintain their protein status.

Regardless, it is advised that patients seek the advice of a registered dietitian to advise on bloating, constipation, early satiety, swallowing problems and the overall balance of their nutritional intake.

May 5, 2020
Renal Diet Maze

A close friend has called on my skills to help him with navigating the maze of restrictions imposed with a renal diet. This was a sudden diagnosis and he is overwhelmed.
First of all, it is important for us all to keep our blood pressure optimally at 130/80, new guidelines to keep our kidneys functioning well. The dietary component which will keep your kidneys healthy includes restricting your salt and keeping your body weight close to target, which may vary depending on your genetics.
Secondly you want to stop smoking or if you are diabetic, you want to keep your blood sugars close to target.
Thirdly if your kidneys stop functioning, you may need to restrict your protein, this preserves kidney function, so the Paleo diet may not be a good choice but a vegetarian diet may also be a difficult choice.
When your kidneys fail, you often need to restrict you potassium- some of those loved fruits (bananas and oranges) and vegetables (tomatoes and potatoes)
Lastly the phosphate in your diet often becomes a problem, this mineral is often found in foods that we naturally choose because they are healthier
dairy, proteins, legumes, nuts, whole grains. There are phosphate binders that you may be prescribed.
The diet for chronic kidney failure in fact doesn’t seem very healthy but is important for your compromised kidney and your longevity.
This new publication has many of the details you need to learn about, including recipes with herbs and spices give more flavour to your food while restricting the salt (sodium). Its available at Gibson’s Library.
If you need help navigating this maze and want your diet analyzed, these are services that I provide, helping you to get on the right track!

February 19, 2018
A most important element in our diet and soil…magnesium

Listened to a brief presentation by Dr.Alan Gaby about magnesium and it kindled my continued interest in the importance of this mineral for immune, bone, muscle and nerve health, most Canadians are deficient in this mineral, our foods and soils are low in magnesium, deficiency is a sign of poor diet or insufficient diet as well as an outcome of alcohol abuse or drug interaction with thiazides, Lasix and proton pump inhibitors, drugs that many of our clients with chronic disease take regularly. Deficiency is often seen with psychosomatic, osteoporosis, heart disease, depression, diabetes and many GI disorders with spasming stomach, possibly irritable bowel disease. He also associated magnesium with asthma, migraines, kidney stone reoccurrence, chronic fatigue and fibromyalgia, and pain management. Although it may be required for all of these conditions, the bottom line is that we should certainly should be aware of its importance and weary of the side effects of too much, which include diarrhea or complications in renal disease or with certain medications including ACE inhibitors. Magnesium from supplements should not exceed 350 mg/day.

Foods that are rich in magnesium include nuts, seeds, soy, legumes, whole grains, dairy, fish and some vegetables. The requirement is 400-420 mg/day for men and 310-320/day for women. Some people are very sensitive to oral magnesium, and may experience diarrhea, usually there is a bowel tolerance rule, it can be given by IV, or orally concentrated, chelated, magnesium oxalate, aspartate and gluconate are all available supplements.

By the way, if you are a gardener, you may want to add Epsom salts to the soil regularly and for that matter, one can throw Epsom salts in your bath, for topical absorption, its magnesium sulfate so you don’t have to worry aboutsodium!

January 1, 2018