Five Star Living, Inc. -- nutrition you can live with !! Kathrynne Holden, MS, RD NUTRITION AND PARKINSON'S DISEASE =20 (Before making any dietary changes, be sure to consult your=20 personal physician and/or registered dietitian. If you decide to change=20 your protein intake, allow about two weeks for the change to have an=20 effect.) A nutritious, balanced daily menu is always important for good=20 health. While we each have slightly different needs, everyone must have=20 carbohydrates, fats, and protein. Minerals like calcium, magnesium, and=20 potassium help manage our blood pressure. Vitamins like A, D, K, E, and=20 folate are responsible for good vision, heart health, proper blood=20 clotting, and healthy bones. And new nutrients are being discovered in=20 foods every day -- flavonoids, phytochemicals, genistein, omega-three=20 fatty acids -- we've all seen these words in the news lately. All these=20 nutrients, and many more, are important, especially for people with=20 Parkinson's disease. Yet those with PD have special needs with regard to nutrition.=20 While they must have carbohydrates, fats, and protein just like everyone=20 else, some foods can interfere with the absorption of the special=20 medications used for PD. Let's take a look at nutrient needs, then see=20 how the medications work, and how food affects them. Then we'll explore=20 ways to get a balanced menu while getting the full benefits from=20 medications. CARBOHYDRATES The best sources of carbohydrates (starches) are whole-grain=20 breads, cereals, rice, and pasta. This is the type of food that we need=20 in the greatest amount in our daily menu. Carbohydrates provide the=20 steady supply of energy needed by the brain, internal organs, and=20 muscles all day and throughout the night. If we don't get enough=20 carbohydrates, the body will break down the proteins of our own muscles=20 and organs, in order to get the energy supply it needs. Stored fat is=20 used in a different way; it can't replace starch. We must get plenty of=20 carbohydrate daily. A serving from the bread group is: one slice bread, 1 ounce=20 ready-to-eat cereal, =BD cup cooked cereal, rice or pasta; 4 small=20 crackers or 2 large crackers; =BD bagel or English muffin. A very small o= r=20 inactive woman needs about six servings a day. A large or very active=20 man needs eleven servings or more daily.=20 FATS Fats are very important, and we need to get them every day.=20 They're part of the coating around each nerve; the vitamins A, D, E, and=20 K cannot be absorbed without first being dissolved in fat; a layer of=20 fat protects our vital organs and cushions our bones.=20 It's important to keep fat in the right proportion in the daily=20 menu, though. Fat takes a long time to get out of the stomach. This is=20 important in PD, because Sinemet mixes with the fat and stays in the=20 stomach along with it. This means it takes a long time for the Sinemet=20 to get to the brain and do its work. And, since Sinemet has a very short=20 lifespan, it's life may be nearly over by the time it gets to the brain. Good fatty foods are raw nuts, seeds, and avocadoes. They all=20 have heart-protective fats, as well as special vitamins and minerals not=20 found in other foods. Fatty foods to use in moderation are fried foods,=20 meats, high-fat dairy products, butter and other spreads, desserts,=20 candy, gravies and sauces. A good idea is to eat some raw nuts daily, and eat small=20 portions of lean meats, fish, and poultry daily. Desserts and fried=20 foods are OK once in awhile. PROTEIN A protein is a long string of tiny molecules called amino acids.=20 Foods highest in protein are meats, poultry, and fish. Next highest are=20 cheese, milk, nuts, seeds, and cooked dried beans. Vegetables, and=20 starchy foods, like potatoes and breads, have protein, too, but only a=20 very tiny amount. Inside the stomach and intestine, the body breaks up the protein=20 string into separate amino acids. The aminos then are absorbed into the=20 bloodstream and delivered around the body to build new muscle, repair=20 damages, and form certain special chemicals in the brain. We need about =BD gram of protein per pound of body weight per=20 day. A 150-pound person needs about 55 grams (two ounces) of protein. =20 Most Americans eat far more protein than that. If your Sinemet isn't=20 absorbed well, it could help to check the amount of protein you're=20 getting each day. PARKINSON'S VS PROTEIN Each of us has different calorie and protein needs. People with=20 Parkinson's have further complications, because protein interferes with=20 levodopa (Sinemet) absorption, both in the intestine and at the brain.=20 And, each person takes different amounts of levodopa, at different=20 times, and in combination with different additional medications.=20 Finally, PD has different stages, and these stages can affect a person's=20 absorption of medications. During the early stages of PD, the brain continues to make some=20 dopamine, so it doesn't have to rely totally on Sinemet. Later on,=20 however, the brain stops producing dopamine. At this time, digestion of=20 protein can greatly slow absorption of sinemet. Why? Because amino acids=20 need a special "carrier" to get across the intestine and into the blood.=20 Then they need another carrier to get from the blood into the brain. The=20 Sinemet uses the same carrier as the aminos. So the aminos and the=20 Sinemet all compete for carriers -- to get into the bloodstream, and to=20 get into the brain. When we eat lots of protein, the aminos win the=20 race. Another problem is that Sinemet doesn't last very long. It only=20 stays in the blood for about one hour to an hour-and-a-half. Once it's=20 gone, the "off" period or "freezing" may return, especially in the later=20 stages of PD. This means that it's imortant for the Sinemet to get to=20 the brain as fast as possible.=20 Sinemet can travel quickly through the stomach, into the=20 intestine, and from there to the bloodstream when it's taken by itself.=20 Food takes longer to get out of the stomach--especially fatty foods and=20 fiber. If you take Sinemet with food, its short lifespan may be half=20 over by the time it gets out of the stomach. By the time it gets into=20 the bloodstream, and up to the brain, its life is almost at an end. So=20 it's important to get the Sinemet into the bloodstream as quickly as=20 possible. PARKINSON'S AND CARBOHYDRATE Carbohydrate plays a special role in PD. Carbohydrates are=20 converted into sugar, and released into the bloodstream. Sugar needs=20 insulin in order to get into cells where it's used for fuel. The rush of=20 insulin also removes some of the aminos that compete with levodopa. So=20 eating plenty of carbohydrates with protein may help some people. TO GET THE MOST OUT OF YOUR SINEMET: 1) If your Sinemet works well, and you don't experience any "off"=20 or "freezing" periods, your brain is most likely making some dopamine.=20 That, plus the Sinemet, is probably sufficient for your needs, and=20 unless your doctor says otherwise, you don't need to worry about protein=20 at this time. 2) If you have begun to experience some "off" times or "freezing"=20 it's possible that your brain's production of dopamine has slowed or=20 stopped; and that protein, excess fat, or fiber is preventing the=20 Sinemet from leaving the stomach quickly, and being absorbed by the=20 brain.=20 The recommendation is to take Sinemet 30 to 60 minutes before a=20 meal. The stomach needs about 45 minutes to empty; so the sinemet=20 passes out of the stomach into the intestine without interference from=20 protein. The medication is absorbed from the intestine into the=20 bloodstream, and gets to the brain before the food can get out of the=20 stomach. If you find that Sinemet by itself makes you nauseous, try=20 taking it with some carbohydrates, such as fruit juice and crackers.=20 Then eat your meal 30-60 minutes later. 3) If this approach doesn't work well, it may be that you're=20 getting too much protein. It's still recommended to take Sinemet 30-60=20 minutes before a meal. Then, to figure out your personal protein and=20 calorie needs: -Start with your weight -Divide this by 2.2 to get kilograms -multiply the result by 30 to get your calorie needs for one day -multiply the result by .8 to get your protein needs (in grams)=20 for the day Example: A 150-pound man would divide his weight by 2.2 to get=20 his weight in kilograms: 150/2.2 =3D 68.2 kg 68.2 kg X 30 =3D 2045 calories per day 68.2 kg X .8 =3D 55 grams of protein per day Now that we know his calorie and protein needs we'll use a=20 special food chart (see FOOD SERVING SIZES) to design two menu plans for=20 him. Calorie and protein amounts rarely come out exactly, so we'll aim=20 to stay within about 100-200 calories, and within about 10 grams of=20 protein. Our food chart shows the approximate amounts of carbohydrate=20 and protein in the main food groups. For more exact amounts, you need a=20 diet manual. NOTE: Some people with PD burn extra calories, leading to weight=20 loss. If you are losing weight, it's important to get extra servings,=20 especially of carbohydrates, fruits, and vegetables. You may need to=20 locate a source of low-protein breads, to cut down on protein. Aproten,=20 Paygel, and Cellu make such low-protein products. You may be able to=20 find them at health food stores, larger supermarkets, or specialty food=20 stores. FOOD SERVING SIZES Breads, grains 1 slice bread 1 cup cold cereal =BD cup cooked cereal, rice, or pasta=09 15 grams carb/ 3 grams protein/ 80 calories -------------------------------------------------------------------------= -------------------------- Vegetables =BD cup cooked veg. =BD cup chopped raw veg. 6 oz veg. Juice l cup raw leafy greens=09 5 grams carb/ 2 grams protein/25 calories -------------------------------------------------------------------------= -------------------------- Fruit 1 medium apple, banana, or orange;=20 =BD cup fresh berries;=20 15 grapes;=20 =BD cup applesauce;=20 1/4 cup dried fruit;=20 3/4 cup fruit juice=09 15 grams carb/ 0 protein/ 60 calories -------------------------------------------------------------------------= -------------------------- Dairy (low or reduced=20 fat choices) 8 oz milk or yogurt : 12 grams carb/ 8 grams=20 pro/ 100 calories 1 =BD oz cheese : 1 gram carb/ 10 grams protein/=20 150 calories 1 cup cottage cheese : 6 grams carb/ 28 grams=20 protein/ 160 calories -------------------------------------------------------------------------= -------------------------- Protein (medium-fat meat, poultry choices)=09 1 oz meat, poultry, fish: 3 grams carb/ 7 grams=20 protein/ 75 calories 1 cup cooked dried beans : 30 grams carb/ 7=20 grams protein/ 225 calories 1 egg : 0 grams carb/ 6 grams protein/ 80=20 calories Mixed nuts, 1 ounce (4 TB) : 5 grams carb/ 7=20 grams protein/ 175 calories Peanut butter, 2 TB 5 grams protein/ 9 grams=20 carbo/=20 185 calories -------------------------------------------------------------------------= -------------------------- Fats Butter, margarine, 1 tsp: 0 carb/ 0 protein/ 45=20 calories Avocado, 1/4 : 3 grams carb/ 1 gram protein/ =20 75 calories -------------------------------------------------------------------------= -------------------------- MENU PLANS One approach is to use the food chart to spread the protein=20 throughout the day, in small amounts (see PLAN 1). However, some people=20 still find that they have reduced mobility during the day. They may wish=20 to try eating the bulk of their protein at the evening meal (see PLAN=20 2). PLAN 1 (Protein is spread throughout the day. This plan may work best for=20 people with good mobility. Calories and protein are about right for a=20 150-pound person -- 2000 calories and 55 grams protein. Discuss this=20 plan with your physician before you start.) BREAKFAST: =09 6 oz orange juice : 15 grams carb/ 0 protein/ 60 calories 1 egg : 0 carb/ 6 gram protein/ 70 calories 2 slices whole-wheat toast : 30 grams carb/ 6 grams protein/ 160=20 calories 1 TB butter : 0 carb/ 0 protein/ 100 calories 2 TB jam : 26 grams carb/ 0 protein/ 100 calories 1 cup fresh fruit : 30 grams carb/ 0 protein/ 120 calories Total for breakfast: 101 grams carb/ 12 grams protein/ 610 calories LUNCH:=09 1 cup bean soup : 20 grams carb/ 6 grams protein/ 150 calories 8 saltines : 30 grams carb/ 6 grams protein/ 160 calories 2 TB pnut butter : 6 grams carb/ 9 grams protein/ 200 calories =BD cup carrot sticks : 5 grams carb/ 2 grams protein/ 25 calories 1 cup fresh fruit : 30 grams carb/ 0 protein/ 120 calories 4 oz 1% or skim milk : 6 grams carb/ 4 grams protein/ 50 calories Total for lunch: 96 grams carb/ 27 grams protein/ 705 calories DINNER:=09 2 oz broiled chicken : 0 carb/ 14 grams protein/ 130 calories 1 small baked potato : 25 grams carb/ 2 grams protein/ 100 calories 2 TB sour cream : 1 gram carb/ 1 gram protein/ 50 calories 2 cups tossed salad : 4 grams carb/ 2 grams protein/ 25 calories 2 TB Oil & Vinegar Drsg. : 0 carb/ 0 protein/ 100 calories 1 dinner roll : 15 grams carb/ 3 grams protein/ 80 calories 1 TB butter : 0 grams carb/ 0 grams protein/ 100 calories 4 oz skim or 1% milk : 6 grams carb/ 4 grams protein/ 50 calories Total for Dinner: 51 grams carb/ 26 grams protein/ 635 calories TOTAL FOR DAY: 248 grams carb/ 65 grams protein/ 1950 calories -------------------------------------------------------------------------= -------------------------- PLAN 2 (Protein is mainly restricted to the evening meal; this may improve=20 daytime mobility for people who have greater shifts "on and off" in=20 their ability to move. Calories and protein are about right for a=20 150-pound person -- 2000 calories and 55 grams protein. Discuss this=20 plan with your physician before you start.) BREAKFAST =09 6 oz orange juice : 15 grams carb/ 0 protein/ 60 calories 3/4 cup Whole Grain Total : 24 grams carb/ 3 grams protein/ 110 calories 4 oz non-dairy creamer : 16 grams carb/ 0 protein/ 176 calories 1 cup fresh fruit : 30 grams carb/ 0 protein/ 120 calories Total for Breakfast: 85 grams carb/ 3 grams protein/ 466 calories LUNCH =09 1-1/2 cups vegetable soup (no meat, poultry or beans) : 30 grams carb/ 3=20 grams protein/ 195 calories 2 large rye crackers : 15 grams carbohydrate/ 2 grams protein/ 80=20 calories 1 medium banana : 15 grams carb/ 0 protein/ 80 calories 8 oz tomato juice : 5 grams carb/ 0 protein/ 45 calories Total for lunch: 65 grams carb/ 5 grams protein/ 400 calories DINNER =09 8 oz 1% or skim milk : 12 grams carb/ 8 grams protein/ 100 calories Cheeseburger, containing --=20 4 oz hamburger : 0 carb/ 28 grams protein/ 300 calories 1-1/2 oz cheese : 0 carb/ 7 grams protein/ 150 calories 1 bun : 30 grams carb/ 5 grams protein/ 160 calories 1 sliced tomato : 5 grams carb/ 1 gram protein/ 25 calories 1 cup ice cream : 31 grams carb/ 5 grams protein/ 300 calories 2 oatmeal cookies : 16 grams carb/ 1.5 grams protein/ 120 calories Total for Dinner: 94 grams carb/ 55.5 grams protein/ 1155 calories TOTAL FOR DAY: 244 GRAMS CARB/ 64.5 GRAMS PROTEIN/ 2021 =09 CALORIES -------------------------------------------------------------------------= -------------------------- =09 Again, though, because PD may follow several stages, and is=20 further complicated by different types of medications, in different=20 dosages, these menu plans may require experimenting. One person may get=20 along fine getting most protein in the evening, while another may find=20 sleep impossible due to "freezing." You will need to try your Menu Plan for about two weeks; if you=20 don't feel any better by then, protein changes are probably not the=20 answer. The amount of Sinemet you use and the stage of PD are important=20 factors. But studies show that about 60% of people respond favorably to=20 protein changes. Also, some people find that a particular protein food, such as=20 dairy products or meat, blocks absorption of Sinemet. First, try eating=20 a smaller amount of that food -- say, 4 ounces of milk, or one ounce of=20 meat at a meal. If symptoms still persist, it may be necessary to adopt=20 a vegetarian or semi-vegetarian menu plan. Cooked dried beans are an=20 excellent source of protein, minerals, fiber, and carbohydrates. They=20 also have a large proportion of carbohydrates, compared to protein.=20 Nuts, and seeds such as sunflower and sesame seeds, contain both protein=20 and heart-protective fats, as well as important trace minerals not=20 easily found in other foods. However, if you're not able to tolerate milk at all, it's best=20 to take a calcium supplement, as well as vitamins A and D. And if you=20 can't tolerate any animal protein, such as meat, poultry, fish, dairy=20 products, or eggs, you should also take a B12 supplement that meets the=20 RDA of two micrograms per day. A good idea is to take one of the many=20 excellent multivitamin/mineral supplements on the market. If you're in=20 doubt, ask your physician or a pharmacist. --=20 Kathrynne Holden, MS, RD Editor-in-Chief, "Spotlight on Food--nutrition news for people 60-plus" Tel: 970-493-6532 Fax: 970-493-6538=20 http://www.fortnet.org/~fivstar You may wish to contact: Better Business Bureau of the Mountain States, < [log in to unmask]> for further information.