On Monday, April 26,  Kathrynne Holden, MS, RD, author of "Eat Well, Stay
Well with Parkinson's DIsease" and list member extraordinaire, gave a talk at
the Parkinson's Association of Greater Kansas City annual symposium.  The
other two speakers were Dr. William Koller and Dr. Raj Pahwa who both spoke
about research.  We hope to have a write-up on their talks at a later date.

The following report was initially written by Mary Ruth Kittrell from her
notes, and has been reviewed and edited by Kathrynne who retains the
copyright on it.
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        Many nutrition-related hospitalizations of people with PD can be
prevented. It's important, though, to understand how PD affects the
gastrointestinal tract.

        Parkinsons disease can affect the nerves of both the voluntary and
involuntary nervous systems.  The voluntary nervous system guides the
muscles responsible for picking up an apple and chewing it. The
involuntary nervous system guides the muscles of the gastrointestinal
tract, which are responsible for moving food through the throat,
stomach, small intestine, and colon.

        At the point of swallowing, the involuntary nervous system takes
over.
And Parkinsons disease tends to slow down the involuntary nervous
system. Throat muscles may be affected, causing choking. The esophageal
sphincter doesn't always close properly, allowing food and stomach acids
to come back up into the throat (acid reflux). These acids can be
inhaled into the lungs, causing aspiration pneumonia and
hospitalization. Acid reflux can also scar and damage the esophageal
sphincter and throat, making it even more difficult to swallow.
        Stomach movement may also be slowed down, resulting in bloating, and
increasing the likelihood of acid reflux. Foods that can trigger reflux
include alcohol, tomatoes, citrus fruits, caffeine, chocolate and large
meals, especially those high in fat.  If you're troubled with reflux,
try to eat smaller meals and eat more frequently.  Avoid foods that
trigger reflux.

        For difficulty with acid reflux, ask for a referral to a registered
dietitian who specializes in Parkinson's disease. If you have problems
with swallowing or choking, your doctor can refer you to a speech
language pathologist who can help you learn safe swallowing techniques.

        Slowed movement of the large intestine can lead to hard stools which
can then result in fecal impaction (blockage of the colon). Sometimes
watery diarrhea seeps around the blockage, leading the individual to
believe that s/he is not constipated. If you have been constipated, and
experience abdominal pain and/or diarrhea, you should see a doctor
immediately, to determine if fecal impaction is present.

        Chronic constipation can increase risk for colorectal cancer. Colon
cancer is among the easiest to prevent if detected early. All persons
over age 50 should receive an annual check for colorectal cancer,
including a sigmoidoscopy or colonoscopy. People with chronic
constipation should be especially careful to have colorectal cancer
screenings.

        In a study I performed of 24 people with PD, almost all reported
frequent constipation. Yet the average daily fiber intake was 11 grams
-- about one-third the amount needed. All healthy people are advised to
get at least 25 grams of fiber daily; if you experience frequent
constipation, aim for 30-40 grams. Suggestions:
        Start the day with a high-fiber breakfast cereal that contains at
least
5 grams of fiber;
        Get plenty of fruits and vegetables, at least five servings a day --
these are not only rich fiber sources, they protect against colorectal
cancer;
        Choose whole wheat crackers instead of saltines.
        Choose servings of cooked dried beans, split peas, or lentils
frequently. These are especially rich in fiber. Baked beans, three-bean
salad, split pea or navy bean soup, refried beans -- all are excellent
choices.

        Fiber has the added bonus of retaining water while it passes through
the large intestine, and this helps keep the stool soft. Drink plenty of
fluids along with the fiber, at least 6 to 8 glasses of water daly. If
you get plenty of fiber and fluids, and still experience constipation,
try a few prunes or a glass of prune juice 2 or 3 times a week.
Exercise, like walking, seems to stimulate the colon and helps promote
regularity.

        Finally, if diet and exercise have not helped your constipation, see
your physician who may wish to prescribe medications -- avoid
over-the-counter laxatives, which can damage the colon.

        Consider drinking tea daily, as part of your fluids -- black or green
tea, regular or decaffeinated, hot or iced, all contain protective
flavonoids. In fact, a cup of tea contains about the amount of
flavonoids as a serving of vegetables. Although green tea is somewhat
richer in flavonoids than black tea, both are helpful.

        Besides helping control constipation, fluids are needed to help
prevent
urinary tract infections, which are common to people with PD, and can be
fatal. Along with plenty of water, a glass of cranberry juice daily can
help to prevent urinary infections. Some Parkinsonians complain that
drinking water causes them problems--they can't always get to the
bathroom quickly enough, so they avoid drinking water.  Suggestion:
drink at least 8 oz. of water each time you take your medications. This
improves the odds that you will be "on" when your bladder needs
emptying.  If you have "dry mouth," though, it's better to sip water
frequently all day, to keep the mouth and gums moist and help prevent
dental problems.

        Because of the nutrition risks often associated with PD, it may be
advisable to take multivitamin/mineral supplements. Ask a registered
dietitian (preferably one who specializes in Parkinson's disease), or
your doctor, about the advisability of a multivitamin such as Centrum or
One-A-Day. If you are over age 50, and are not anemic, choose one that
contains little or no iron, such as One-A-Day 50-Plus. Multivitamin
pills should also contain important trace elements, like copper,
selenium, chromium, and others. Unless you are allergic to nuts, two
tablespoons of raw mixed nuts a day are a good idea. Nuts are a
powerhouse of trace minerals, rich in heart-protective fats, and an
important source of natural vitamin E.

        People with PD are more likely to experience bone thinning and
fractures, therefore it's important to get enough bone-strengthening
nutrients. This includes 1200 to 1500 mg of calcium a day. Many people
need to use supplements, calcium-fortified orange juice, or
calcium-fortified cereals or other foods, in order to get this much
calcium. Multivitamins, such as Centrum, do not contain enough calcium
to be a good source.

        Tums and many other calcium supplements contain calcium in the form of
calcium carbonate, which is an antacid.  Calcium carbonate can cause
constipation in some people; if so, try calcium citrate.

        Calcium citrate (which is not an antacid) may also be a better choice
for older adults, who often produce less stomach acid. Stomach acids are
needed for absorption of some nutrients. If you have acid reflux,
however, discuss calcium supplements with your doctor or registered
dietitian. (Note: calcium cannot be absorbed by the body if you are not
getting adequate Vitamin D, found in fortified milk and cereals, in
supplements such as Centrum and One-A-Day, and by exposure to sunlight.)
It is also important for bone health to get 400 mg of magnesium daily,
and a supplement may be needed to get this amount.

        Finally, people with PD -- both men and women -- should have regular
bone scans to detect bone thinning early and prevent fractures. Bone
scans may be either ultrasound or a Dexascan; your doctor will be able
to provide a referral for such a scan.

        Preventing nutrition-related hospitalizations is an attainable goal
for
everyone. Care with meal planning, supplements, exercise, and proper
screening can help keep people with PD in good health.  If you have
questions, ask your physician for a referral to a registered dietitian,
preferably one who specializes in Parkinson's disease.
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Submitted to the list by Barbara Blake-Krebs   [log in to unmask]