Progressive weight loss and undernutrition is a major feature of PD, particularly as the disease progresses.
This can be due to a number of reasons. First people with Parkinson’s burn more energy due to their tremors and dyskinesias. Medications may result in nausea and loss of appetite. Neurocognitive issues such as decline in memory (forgetting to eat), depression etc. may also lead to weight loss. Also symptoms may interfere with shopping and food preparation resulting in poor food intake.
Weight gain is also an issue for those with Parkinson’s. It is very common following surgical procedures such as deep brain stimulation which when successful improves the symptoms of PD, reducing the amount of energy burned by dyskinesias and tremors. Patients post-DBS also often describe an increase in appetite. An increase in appetite and resulting weight can also be due to medications such as dopamine agonists which can cause compulsive eating as a side effect and MAO-B Inhibitors can also cause weight gain. And patients whose symptoms of Parkinson’s are not dominated by tremors but instead slowness and stiffness will likely gain weight as well.
Good nutrition is critical in overall health and well-being and malnourishment can result in significant problems. These include a weakened immune system resulting in an increase in infections, weaker muscular strength and poor energy. Mood issues and cognitive decline may also be consequences of poor nutritional status. And of great concern is poor bone health which when combined with the increased fall risk seen in Parkinson’s, significantly increases the chances of fractures.
So how can you maintain a healthy weight?
(1) First of all, weigh yourself regularly so that you can detect a problem early on. Body weight is a good reflection of nutritional status. If you notice a weight loss (or weight gain) of 5 lbs. or more in a week, it is time to involve your physician.
(2) A dietician can help design a menu that takes into consideration your weight goals and physical limitations.
(3) Difficulty swallowing should be evaluated by a speech and language pathologist. Based on the results, a specific type of diet (food texture and size) that would be suitable can be provided.
(4) Sometimes if there is dysphagia (difficulties in swallowing) or delayed gastric emptying (bloating and feeling overly full following a meal) it may be better to eat 5 or 6 smaller meals throughout the day instead of 3 larger meals.
(5) Don’t waste your appetite on empty calories, i.e. foods with little nutritional value such as potato chips or candy bars. Choose instead nutritionally dense foods such as peanut butter cheese, yogurt etc.
(6) If meal preparation is difficult for you, enlist the help of family or friends or on a good day prepare extra meals yourself that can be frozen and reheated when needed. Depending on where you live there may be government community services or private companies that deliver ready-made meals as well. And make food preparation easier by using the many easy and convenient short cuts that are available when preparing your meals. Buy precut vegetables, premarinated meats and ready made sauces. Not to mention the huge variety of fully prepared and often healthy meals that can be found in your supermarket deli, frozen food aisle or grocery store shelves. If physically getting to the store is difficult, enlist the services of a grocery delivery service.
(7) Supplementary shakes or nutritional supplements can provide much needed extra, nutritionally dense calories between meals.
(8) Save your drinks for after or between your meals so that you don’t eat a smaller amount of nutritious foods because you’ve filled up with liquids.
(9) Exercise. This is necessary for everyone regardless of age or health but is particularly important for those with Parkinson’s for a number of reasons including maintaining a healthy weight, increasing muscle mass and bone strength.
(10) The amino acids in protein compete with dopamine being absorbed and in some individuals this can result in poor symptom control when Parkinson’s medications are taken around a protein-rich meal. In those situations, taking medications a half hour prior to or two hours after a meal containing protein is recommended. At one time protein restriction was used to manage this issue but now it is increasingly recognized that this approach can actually result in malnourishment and weight loss. Taking medications on an empty stomach or protein redistribution may be more appropriate. In this latter scenario, protein intake is primarily included late in the day when fewer active commitments may be scheduled.
Most of these points are logical and fairly easy to incorporate into your daily routine. What they all have in common is the need to first recognize the problem and then active management of the issue. You must treat your nutritional status as an important factor in maintaining your general health and quality of life; a necessary aspect to optimize so that you are able to face the many other challenges of Parkinson’s disease.