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> I spoke with the daughter of a PWP yesterday who was very concerned about > her father's weight loss. He has dropped from 165 to 105 and has lost > interest in eating even when his favorite meals are prepared. I understand > that loss of appetite due to changes in sense of taste & smell is common > but what actions have others taken to combat such a dramatic and obviously > unhealthy loss of weight? Hi Ken, I could joke and say I wish I had that problem (being around 185; or is that being a round 185?) but it is too serious for that. Small weight losses, 10-30 pounds, can be caused by the increased metabolic conversion of food to energy in response to the extra energy needs of muscles affected by the violent tremors or involuntary movements of dyskenesia. I have noted diminished taste and smell in PWP's. In addition to that, exogenous depression can lead to a disinterest in food. Some PWP's are embarrassed to eat in public, having difficulty in handling obstinate cutlery that won't behave, skidding plates that hit other dinners in the tummy, etc. If they cannot get sufficient meals in private for some reason, they can lose weight, also. PWP's who are resident in hospitals or nursing homes can become undernourished if meal times are too rigid, as PD won't always let you eat when you want to, but when you can. Another complication is akinesia involving the pylorus, the valve from the stomach to the intestines. Since levodopa needs to be absorbed in the intestine, rather than the stomach, failure of the pylorus means not only that little or none of the last dosage reaches the brain, but more dopamine is released by interaction in the liver, with subsequent nausea. Then we have dysphagia (difficulty in swallowing), with reflux oesophagitis, (heartburn), peptic oesophagitis (often resulting in a peptic ulcer), poor peristalsis (the wave-like undulations that send food from the throat to the stomach) resulting in the bolus (ball of food) remaining in place in the throat. This is complicated by the abundance and viscousness of saliva typical of some stages of PD. The result of any of these can be choking, and pooling of food leading to aspiration of particles into the trachea, then into the lungs. This in turn can lead to pneumonia. It is a wonder we even bother with eating, and just fade away gracefully instead! Sooo.... Some of the things we can do are: 1. Make food more appetising with spices, herbs, strong flavours such as spanish onion, tomato, etc. (Watch for intolerance of acidic foods, etc., however.) 2. Serve moist food such as casseroles, soup, or moisten with sauces or gravy. 3. Avoid food that is likely to ball in the oesophagus, such as polished white rice, dry mashed potato, over-processed cereal, fresh white bread, etc. If such foods are necessary in a particular PWP's diet, they should be eaten in quite small mouthfuls, with pauses between mouthfuls, and sips of water to help the food down. 4. Cut meat into small sections, say 1/2 inch on a side, and chew thoroughly before swallowing. 5. Preferably, eat several small meals rather than a few large ones. 6. Avoid fatty foods, hot spices such as chilli, and carbonated gassy drinks. 7. Have a "treat" every so often; something the PWP really enjoys. This will foster favourable anticipation of meal times. 8. Use easily manipulated cutlery, such as that designed for people with arthritis, etc. Consider non-slip mats under plates and glasses, plates with inward-turning lips, mugs with attached covers, etc. 9. Try to create a pleasant ambience for meal-times; no "plate-on-the-knee" in front of the tellie. 10. Make sure thee diet is adequately balanced, with appropriate amounts of protein, carbo-hydrates, fats, sugars and dairy products. Remember that if the diet is inclined to the liquid side, extra "energy" foods may be necessary. 11. Food that might be difficult to chew and/or swallow can be liquidised. 12. Watch the salt content. Lemon juice can be added as a substitute, and white pepper, not in excess, can generally be used to attract the tastebuds. 13. Drink plenty of liquids daily, 3-4 pints at least. Avoid or substantially lessen the intake of cola (sorry, Coke and Pepsi!), caffeinated drinks (tea and coffee), and alcohol, particularly beer, which are diuretics (increasing the flow of urine). If they are taken, they *don't* count towards the recommended liquid intake. 14. Seek out a good dietitian, and ask their advice in preparing an extensive menu. Make them aware of the PWP's unique requirements and medication - a diet that may be ideal for a non-PD person may cause unwanted complications for a PWP. 15. Above all, include your physician in the diet planning. It is unwise to radically alter the diet without your doctor's knowledge and advice. In extreme cases it may be necessary to feed the patient intravenously, or through a nasogastric tube, until they can take nourishment for themselves. See your medico to check that the problem is not one of endogenous (chemical-caused) depression, and not connected with a non-Parkinsonian disorder. Jim