Parkinson's Disease

Description

Alternative Names

Lifestyle Changes

No special diets or natural foods have been shown to slow down the progression of Parkinsons disease, but there are some dietary recommendations.

Protein. High levels of proteins compete with levodopa for transport to the brain and reduce its effectiveness. Avoiding protein altogether is not the solution, since malnutrition can result. Most experts now recommend trying to maintain a carbohydrate-to-protein ratio of 7:1 throughout the day. This may be difficult to calculate and some physicians recommend simply keeping proteins to 12% of total daily calories.

As an aid in calculation, it may be helpful to note that food labels indicate proteins in grams and that one gram of protein equals four calories. Good control of protein intake may help minimize fluctuations and wearing-off and may allow some patients to reduce their daily levodopa dosage.

Restricting Calories. Animal studies indicate that reducing calorie intake may help reduce toxic effects on nerve degeneration.

Fruits and Vegetables and Increasing Fiber. Eating whole grains, fresh fruits and vegetables is the best approach for any healthy life. A diet rich in fruits and vegetables may help protect nerve cell function. Many of these foods are also often rich in fiber, which is particularly important for helping to prevent constipation.

Dietary fiber is the part of food that is not affected by the digestive process in the body. Only a small amount of fiber is metabolized in the stomach and intestine, the rest is passed through the gastrointestinal tract and makes up a part of the stool. There are two types of dietary fiber, soluble and insoluble. Soluble fiber retains water and turns to gel during digestion. It also slows digestion and nutrient absorption from the stomach and intestine. Soluble fiber is found in foods such as oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables. Insoluble fiber appears to speed the passage of foods through the stomach and intestines and adds bulk to the stool. It is found in foods such as wheat bran, vegetables and whole grains. Fiber is very important to a healthy diet and can be a helpful aid in weight management. One of the best sources of fiber comes from legumes, the group of food containing dried peas and beans.

People whose diets have been low in fiber should increase it gradually. It is best to obtain dietary fiber, soluble or insoluble, in the natural form of whole grains, nuts, legumes, fruits and vegetables. If it proves difficult to do so, psyllium, a grain naturally found in India, is an excellent soluble fiber supplement (Metamucil, Fiberall, Perdiem Fiber). Fluids are particularly important in preventing constipation.

Fish Oil. Omega-3 fatty acids, which are found in oily fish, are proving to have powerful anti-inflammatory effects and may also be nerve protective.

Click the icon to see an image of foods that contain omega-3 fatty acids.

Dairy Products. A 2002 study reported a higher risk for Parkinson's disease in men (but not in women) who consumed high amounts of dairy products. This association was not linked to fats in dairy foods and high intake of calcium or protein from other sources did not increase the risk. More research is needed to determine if dairy foods actually increase the risk for PD and if restricting them in male PD patients would be helpful.

Vitamins.

• B Vitamins. Most B vitamins play important roles in the brain and central nervous system. Vitamin B6 (pyridoxine) theoretically has benefits for PD because it is necessary in the production and metabolism of dopamine. Folate deficiency may increase toxic effects against dopamine neural pathways, perhaps by increasing levels of homocysteine, an amino acid that may play a destructive role in many diseases, including heart and neurologic disorders. Some evidence suggests that L-dopa elevates homocysteine levels, so folate supplements may be particularly important for PD patients. Although the major food sources of B vitamins are meats and dairy products, which are high in protein, these vitamins are also found in whole grains and are added as supplements to commercial cereals.

Click the icon to see an image of the benefits of vitamin B6.

Click the icon to see an image of the food that contain vitamin B6.

Click the icon to see an image of food that contain folate.

• Vitamin E. Antioxidant vitamins, especially vitamin E, have been investigated for its effect on the brain. Some, but not all, studies have reported slower mental decline and lower risk for Parkinson's and Alzheimer's disease in people who took vitamin E supplements or had a high intake of foods rich in vitamin E. Such foods include vegetable oils (particularly wheat germ oil), sweet potatoes, turnip greens, mangos, avocados, nuts, sunflower seeds, and soybeans.

The Protective Effects of Nicotine and Coffee on Parkinson's Disease

Both smoking and coffee drinking have been associated with lower risk for PD. Researchers are attempting to discover if these substances protect nerve cells. One interesting 2002 study suggested that the early disease process in PD produces changes in the dopamine pathway that actually protects an individual from caffeine and nicotine addiction, so that fewer PD patients have a history of smoking and caffeine. Research is needed to determine why these toxic substances protect against PD.

Smoking and Nicotine Replacement. Cigarette smokers appear to have a 40% lower risk for Parkinson's disease, indicating some protection by nicotine. This finding, of course, is no excuse to smoke, but such protection may help researchers develop new therapies. Studies on nicotine replacement, such as gum or patches, have been conflicting, however, with some short-term studies reporting no benefits. A 2002 study suggested that nicotine replacement may help smokers with early PD, but not nonsmokers.

Coffee Consumption. Studies have indicated that the risk for PD in coffee drinkers is about 30% lower than for non-coffee drinkers. In one 30-year 2000 study of Japanese-American men, for example, coffee consumption was associated with a lower risk for Parkinson's disease and the more coffee they drank, the lower their risk became. It should be noted, coffee and tea can reduce fluids by increasing urination and so may increase constipation in PD.

Rehabilitation, Exercise, and Other Helpful Therapies

Physical therapy is extremely important for the Parkinsons patient and usually follows an approach that uses active and passive exercise, gait training, practice in normal activities, and if needed, hot or cold treatments, water therapy, and electrical stimulation. Exercise is also essential for well-being; it is a common denominator in patients who are able to maintain productive years. To date, no specific approach has been proven to be better than others.

Exercise Programs. Exercise programs are used defined as passive or active.

• Passive exercise, mostly stretching and manipulation of muscles by a physical therapist, is aimed at preventing muscles from shortening. A passive exercise program that begins with slow and gentle exercises and becomes progressively more intense may improve mobility in patients with early and mid-stage Parkinsons disease.
• Active exercises are used to help range-of-motion, coordination, and speed. Patients should continually make efforts to practice movement, even simple ones, such as marching in place, making circular arm movements, and raising the legs up and down while sitting. Patients who enjoy sports or the use of exercise equipment should continue with these activities even if their skills diminish, assuming there are no other medical conditions that would prevent them.

Gait Training. Practicing new methods for standing, walking, and turning may help retain balance. The following tips may be helpful:

• Take large steps when walking forward, raising the toes at the forward step, and hitting the ground with the heel.
• Take small steps while turning.
• When walking or turning, have the legs 12 to 15 inches apart to provide a wide base.
• Do not wear rubber or crepe-soled shoes because they grip the floor and may cause the patient to fall forward.
• Using devices that keep a rhythmic beat, such a metronome (a simple device used by musicians to keep time), may be very effective, possibly more than music itself, in helping patients to walk faster and take longer steps. One study found that setting a metronome rhythm to about 10% faster than the patients fastest gait offers significant improvement over walking to no rhythm at all or to a rhythm that matches the gait.

Reducing Muscle Freezing. The patient should practice regular daily activities that simplify actions and reduce the incidence of muscle freezing. Most often, freezing occurs when a patient begins to move or is presented with an obstacle. Walkers do not appear to be helpful for freezing. The following may be helpful.

• Rock from side to side.
• If the legs feel frozen, lift the toes. This simple action may free spasm in some cases.
• Hum marching tunes. In fact, music has been shown to help people move and to get out of bed in the morning. Some report that wearing a Walkman and turning music on in situations associated with freezing, such as crossing a street, is helpful.
• Divide actions into separate events, which may prevent freezing that occurs from trying to coordinate too many physical operations at one time. For instance, when going through a doorway, approach the door, stop at the door, open it, stop, and then walk through the doorway.
• A cane equipped with a laser pointer may be helpful, at least temporarily.
• Simply being touched by another person can sometimes release the patient (although a Parkinsons patient should never be pulled or pushed).

Sleep Deprivation Therapy. Sleep deprivation therapy may have a role in treating some cases of depression and some studies are finding some benefits on the depression, tremor, and rigidity experienced by Parkinsons patients. Scientists believe that sleep deprivation produces certain anticholinergic effects, which may ameliorate both depression and Parkinsons symptoms.

Alexander Technique. The Alexander technique is a method that trains a person to change movement habits in order to release tension and improve balance. A 2002 study reported that it may have sustained benefits for patients with PD.

Mental Tasks. Mental training may actually increase dopamine in the brain. And some studies indicate that being mentally fit may be as important for PD patients as being physically fit. Helpful approaches may include the following:

• Select and learn new hobbies that require finger and hand mobility, such as sewing, carpentry, fishing, or playing cards.
• Practice deep breathing and relaxation exercises. These may help maintain proper speech control, control tremor, and reduce anxiety.
• Both the patient and any caregivers should consider psychologic therapy and support for depression and loss of motivation. (One study suggests that marital stress can even produce loss of mobility.) Even if psychological therapy is too costly, inexpensive support programs and groups are widely available and can be invaluable for the patient and the family.

Speech Therapy. Speech therapy may help those who develop a monotone voice and lose volume, particularly in combination with medications. There are no well-conducted studies comparing specific speech therapies, but the Lee Silverman Voice Treatment (LSVT) appears to be an example of an effective technique. It has five major components:

• Focus on the voice (think loud/think shout).
• High effort (pushes patients to overcome limitations).
• Intensive treatment (16 sessions in one month).
• Calibration (learning to know and accept the amount of effort needed to produce normal sound so it becomes automatic).
• Quantification (continuous feedback to objectively document success).

LSVT may not only help speech but may even improve swallowing.

Equipment and Devices. A number of devices can be helpful for maintaining stability and preventing falls. The following are some examples:

• Rails installed where the patient needs support in getting up or down, such as along the bed and in the bathroom.
• Walkers with locking wheels. (Walkers do not appear to be helpful for freezing.)
• Chairs with straight backs, firm seats, and arm rests.
• Firm mattresses and satin sheets or less expensive sheets with high thread counts. (These are useful for helping patients slide out of bed.)