Already in 2012 the nutritionist Angelika Raff described it the site "www.parkinson-web.de“, (a cooperation of the Gertrudis-Klinik Biskirchen and the German Parkinson Association eV) in great detail what you should or even have to pay attention to as a Parkinson’s patient.

It is once again one of those issues that you have to take care of yourself. Neither during my numerous visits to the doctor nor during the clinic and rehabilitation stays was the topic of nutrition given the necessary importance. Even the well-intentioned lectures during my complex therapy were nothing more than a collection of Power Point slides with the quintessence: “Eat healthily”. My mother always told us children that, as true as the statement is, it is not very helpful as a recommendation for action. Fortunately, there are now more and more nutritionists who specialize in neurodegenerative diseases. For example, the Google query “Nutritional advice and Parkinson’s” yields the following result: Google hit list .
But be careful: Not every offer is serious and caution is advised, especially when food supplements are advertised. Promises of salvation are easy to make and we are all too happy to believe in the one remedy that will make us happy.

But read for yourself...

Introduction

Although some countries even produce canned foods for Parkinson's patients, we must start by saying that there is no specific diet for Parkinson's disease. Based on current knowledge, it is also not possible to stop the progression of the disease with a specific diet. Nevertheless, care should be taken to ensure a varied diet in order to ensure an adequate supply of nutrients.

However, there are some peculiarities of the diet of Parkinson's patients, which will be discussed below.

Interaction between L-Dopa and protein

A significant problem is the interaction (interaction between two or more drugs in the sense of a quantitative [weakening or strengthening] or qualitative change in the effect of simultaneous or sequential drug administration) between L-Dopa-containing drugs and the protein intake.

Parkinson's patients treated with L-Dopa can develop an interaction with protein-containing food in the advanced stages of the disease, ie after the occurrence of fluctuations in the effect. Because of this fact, protein restriction with simultaneous L-Dopa treatment came up for discussion. However, we must emphasize that a low-protein diet is not necessary or even harmful.

The interaction between L-Dopa and protein intake is based on the following facts:

1. L-Dopa has a very short half-life in the blood. As a result, the so-called plasma level of L-Dopa is very variable. L-Dopa is absorbed (absorbed) in the small intestine. In the case of gastric emptying disorders, the effect of L-Dopa is reduced.
2. L-Dopa is an amino acid à ​​(carboxylic acids with amino group(s); i.e. the 20 proteinogenic alpha-aminocarboxylic acids that form the primary structure of peptides and proteins; apart from glycine, they are in L-form), the absorption of L-dopa from the small intestine or the penetration into the brain through the blood-brain barrier (blood-brain barrier refers to the obstacle that substances have to overcome when passing from the blood into the nerve cell. This is particularly true for the brain. The blood-brain barrier, for example, makes it difficult for pharmaceuticals to pass into the brain.) is secured by transport mechanisms. These can be saturated very quickly. If other amino acids are present in larger quantities at the same time - this is the case when protein is consumed at the same time - there is an interaction between L-dopa and the other amino acids. Less L-dopa is absorbed, which means there is less in the brain dopamine available. The effect of the L-dopa dose is less or the patient notices no effect at all.

To avoid this interaction, it is recommended that the L-Dopa dose be taken 1,5 hour before or XNUMX hours after food intake.

There are a few exceptions to this recommendation:

1. Patients who do not have this so-called "protein akinesia".
2. Patients in whom the L-Dopa dose taken on an empty stomach triggers nausea and stomach problems. These latter patients can e.g. B. eat a piece of biscuit. If this does not help, then L-Dopa should be taken during the meal. Medicines such as B. domperidone can make the nausea disappear and at the same time accelerate the emptying of the stomach and thereby the absorption of L-Dopa.
3. Some patients develop very severe over-exertion when taking L-Dopa on an empty stomach. These patients should take L-Dopa during meals.

There are some patients who have severe akinesia (off phase) after the main meal in the early afternoon. These patients should try to keep their meals low in protein during the day and get all the protein they need at dinner.

It is also known that carbohydrates (carbohydrates [carbohydrates, saccharides] a collective term for a widespread group of natural substances, which includes all types of sugar, starch and cellulose) play a role in the absorption of L-Dopa, they can affect the L - Promote dopa uptake in the brain. The increased administration of carbohydrates is particularly recommended if the patient has lost weight (eg if severe hyperkinesia occurs). However, a high-carbohydrate and low-protein diet can lead to an increase in hyperkinesia (pathologically increased motor activity, especially in the skeletal muscles with sometimes involuntary movements).

Gastric emptying plays an important role in the effectiveness of L-Dopa. The longer L-Dopa stays in the stomach, the less L-Dopa is available for absorption in the small intestine. Numerous factors influence the rate of gastric emptying; e.g. B. Increased gastric acid production has a slowing effect. Medications such as anticholinergics can also slow down gastric emptying.

Corresponding drugs against gastric acid and drugs that accelerate gastric emptying - such as domperidone - can significantly increase the effect of L-Dopa.

Studies have shown that L-Dopa works fastest when taken on an empty stomach. Dissolvable L-Dopa preparations can significantly accelerate this effect. The dissolved L-Dopa tablet can be helpful for early-morning akinesia (delayed starting) and resorption disorders and swallowing disorders, but also for protein akinesia.

Another important group of drugs are the dopamine agonists, which compensate for the lack of dopamine in Parkinson's disease in a different way than L-dopa preparations. Their effect is usually not affected by meals or a high-protein diet.

Loss of appetite - nausea - weight loss

The trembling, the permanent tension of the muscles and the effort to complete a movement that has been started as well as the L-Dopa-triggered over-movements cost a lot of energy. Medications often cause nausea and vomiting. The result is weight loss. To influence these problems, there are some recommendations regarding food intake:

1. Eat six to even eight small meals throughout the day. An empty stomach promotes nausea, small meals can prevent this.
2. Don't force yourself to eat; reach for the foods you have always loved to eat.
3. All essential nutrients should be adequately supplied with food.
4. Dry crackers, cookies, or toast will help relieve nausea. Eat some of this when you feel nauseous.
5. Easily digestible meals are suitable for nausea, e.g. B. boiled carrots, rice, bananas and white bread.
6. Avoid high-fat, sweet and very spicy foods. Instead, salty, slightly sour and mild foods are suitable.
7. Take your time - enjoy the food. Conscious eating helps to eat right. The eye eats too. Take your time eating. It's fun, encourages you to eat in a variety of ways and promotes the feeling of satiety.
8. The general slowdown often leads to the food cooling down when eating. Warming plates or the ability to reheat food in the microwave will be very helpful.

Indigestion

The disease-related constipation, the lack of exercise, the insufficient fluid intake and the side effects of the medication in Parkinson's disease cause chronic constipation.

Suitable countermeasures are:

1. pay attention to physical activity
2. Eat a high-fiber diet, e.g. B. with wheat bran, prunes, flaxseed, wholemeal pasta, peas, Brussels sprouts, black salsify, peppers
3. Drink a lot, at least 2-3 liters a day
4. to regulate the stool, take swelling agents with plenty of liquid (e.g. macrogol).

dysphagia

In advanced cases of Parkinson's disease, the swallowing process is also made more difficult. In addition, chewing is also impaired. As a result, in such cases, care must be taken to eat a bite-sized diet. Particularly recommended are:

what to eat How to eat

Some general ground rules to keep in mind:

• Reducing calorie intake at the expense of animal fats such as meat, sausage, butter, cheese, egg yolk. The high fat intake results primarily from the increase in the consumption of hidden fats. Therefore, in addition to the visible fats (cut away), the proportion of hidden fats must also be taken into account. If possible, avoid foods with a fat content higher than 30%.
• Avoid household and glucose! Prefer starchy foods. Sugar that our body does not need for energy is converted into fat and stored in adipose tissue. Starch means grains, grain products, potatoes, vegetables. With these starchy foods, the blood sugar level rises more slowly, ie the body can call up its energy when it needs it.

• Divide the food into several smaller meals. For example: breakfast, snack, lunch, snack, dinner.
• About 50% of the total calories consumed daily should come from carbohydrates (carbohydrates [carbohydrates, saccharides] is a collective term for a widespread group of natural substances that includes all types of sugar, starch and cellulose). Food in its natural state has a particularly high nutrient density (high vitamin and fiber content).
• Provide the body with fiber from grains and vegetables. Dietary fiber is indigestible and consists of plant fibers. Their value lies primarily in filling food, thus preventing obesity. However, dietary fiber is also important for regulating bowel movements: wholemeal bread, wholemeal products, e.g. B. whole grain rice, whole grain pasta, muesli, vegetables, fruit, salad. Important!
• Daily fluid intake is also important. Special attention should be paid to this, even if no thirst is felt. On average, a pure drinking quantity of 2 l daily spread over the day is considered desirable, since dietary fibers, as swellable, vegetable fibers, also require a lot of liquid.
• Tip: the proportion in the morning can be higher than the proportion in the evening. Make the drink plan varied, as low in energy as possible but rich in nutrients: mineral water, milk 1,5% fat, mixed milk drinks 1,5% fat, diluted fruit and vegetable juices, fruit tea.

• Make sure you get enough protein from animal and plant foods. As a rule of thumb, half of the daily requirement should be covered by animal protein and the other half by vegetable protein. Recommendation: adults about 0,8 g/kg body weight. Based on medical experience, older people should be given a slightly higher value – around 1,1 to 1,2 g/kg body weight. The most important sources of protein are milk, dairy products (high sources of calcium, important for bone stability), fish, meat and eggs.
• We recommend low-fat sausages, sea fish, low-fat milk and dairy products, low-fat cheeses. Be careful with eggs - they have a very high cholesterol content. One egg covers a person's daily cholesterol requirements.
• Fresh fruit and vegetables should be a daily part of the menu. Enjoy 5 portions of fruit and vegetables a day, as fresh as possible, briefly cooked or as juice - ideal with every main meal or as a snack. This will provide you with plenty of vitamins, minerals and fiber.
• Tasty and gentle preparation is very important for a healthy diet. Cook the respective food as briefly as possible, with little water and little fat and at the lowest possible temperatures. Season creatively with herbs and spices and a little salt.
• Take your time - enjoy the food. Conscious eating helps to eat right. The eye eats too. Take your time eating. It's fun, encourages you to eat in a variety of ways and promotes the feeling of satiety.