Not only can issues around eating negatively impact quality of life, they can also have health consequences. Some research, according to a review article from January 2018 in Frontiers in Aging Neuroscience, suggests that the weight loss and malnutrition associated with Parkinson’s disease may impact disease progression and disability. Here are some of the most common eating and digestion problems that occur with Parkinson’s disease, and expert solutions on how to address them.
Tremor
Tremor is one of the classic symptoms associated with Parkinson’s disease: It’s estimated that about 7 in 10 people with PD will experience a tremor at some point, according to the Parkinson’s Foundation. “Tremor can certainly affect daily function, but the classic tremor of Parkinson’s is what we call a resting tremor — it happens predominantly when the hands are not in use,” says Christine Stahl, MD, a neurologist who specializes in Parkinson’s and movement disorders at NYU Langone Health in New York City. “The tremor tends not to occur as much when holding objects such as utensils or cups.” But some tremors emerge with activity, says Dr. Stahl. “Those can make tasks like holding utensils difficult. Sometimes we recommend trying to time eating to when medications used to reduce the tremor are working really well; that can make the hands better able to hold objects,” she says.
Loss of Manual Dexterity
There can be a decrease in dexterity, and it can be more difficult to perform tasks with the hands, including eating, says Stahl. Dexterity is the ability to use the hands to grasp and manipulate objects and demonstrate small, precise movements. Adaptive eating utensils may help people continue to feed themselves, she says. “We do find that using larger utensils that have a bigger grip area can be helpful, so that they aren’t trying to manipulate small spoon handles.”
Swallowing Problems
Swallowing issues can occur in people with Parkinson’s disease, usually in the later stages of the disease as the illness progresses, says Stahl. The medical term for difficulty with swallowing is dysphagia. “One of the first steps we usually take is to have patients see a speech and swallow therapist to evaluate at what point the swallowing issue may be happening. For example, is it at the beginning part of the swallow, or more at the end of the swallow,” she says. The therapist uses this information to recommend any needed changes, which can include changing the consistency of food or drink, cutting food into smaller pieces, eating at a slower pace, or making purees out of some foods. Calorie- and nutrition-dense smoothies made with kefir, nut or seed milk, and your favorite fruits and vegetables can be a good solution for people with PD who are having swallowing difficulties, according to the Brian Grant Foundation, a not-for-profit advocacy organization for people with Parkinson’s. For some people, swallowing therapy may be recommended, says Stahl. “This is similar to physical therapy for other movements, but the focus is on the swallowing muscles.” The therapy can help increase swallowing control, which can protect the airway and help prevent aspiration (when food or liquid “goes down the wrong pipe”).
Loss of Smell and Taste
Loss of smell can be a very early sign of Parkinson’s disease; sometimes it appears well before any movement symptoms, says Stahl. “However, loss of smell doesn’t mean you have Parkinson’s disease; it could be a number of other things,” she says. Loss of smell can go hand in hand with loss of taste, she says. “When you have a cold or stuffy nose, you definitely don’t taste as well. For some people with Parkinson’s, this loss can translate into a loss of appetite or interest in eating,” says Stahl. Unfortunately, there are no medicines or good therapies to address this symptom, she says. “Often we recommend trying to eat foods with as much flavor as possible; that can increase the palatability of the food. Usually, the sense of smell isn’t totally gone — it’s just reduced — and so that can help.” Spices such as turmeric, oregano, thyme, sage, cinnamon, and cloves, or flavorful sauces like barbecue sauce or chili garlic paste may give food an added boost that makes it more appetizing, according to the Brian Grant Foundation.
Timing of Protein and Meals With Medications
“The main Parkinson’s medication that we use is called levodopa, and when it’s started, it’s typically a three-times-a-day medication, which can be challenging for people to remember and plan around,” says Stahl. Scheduling the medication can be especially problematic for some people with Parkinson’s disease who are sensitive to the absorption of their medicine if it’s timed close to protein or iron intake (in the form of iron supplements), she says. “It’s more of a minority of patients who really notice decreased efficacy of the medication if they time it with a high protein intake, but some very much do.” For people who have more advanced Parkinson’s disease and may be taking the medication three, four, five, or even six times a day, that can get pretty complicated, says Stahl. Because for many people the timing of protein or meals doesn’t cause any noticeable change in the effectiveness of medication, Stahl doesn’t give special instructions about eating when she starts someone on levodopa. “Sometimes having food in the stomach can even help with side effects, including nausea,” she says. If it turns out that the person is sensitive, and they aren’t getting the same benefit from the medicine when taking it with food, particularly protein, then we begin to make changes around the timing of protein, says Stahl. “One strategy that can make things a little easier is to try to compact most of the protein needs of the day into one meal, often the dinner meal. Most people’s schedules are winding down at dinner: They aren’t moving around as much, so if the medicine isn’t quite as effective at this time, it doesn’t have as much of an impact on their daily function,” she says. Another method that works for some people is to take their medicine 30 to 60 minutes before a meal, so that they give the medicine a head start to get absorbed, says Stahl.
Constipation
Constipation is a common symptom of Parkinson’s, and some medications taken for Parkinson’s may also contribute to difficulty with bowel movements, says Stahl. “One way to think about it is that just as walking and other things slow down in a person with Parkinson’s, so does the gastrointestinal (GI) system. There can be a slow transit through the colon and small intestine, and that can certainly cause people to get backed up,” she says. One of the consequences of constipation may be reduced appetite. “The first way we would address constipation in someone with Parkinson’s is the same way we would address it in the general population — through diet. For my patients, I recommend they make sure they are consuming enough fiber,” says Stahl. Women should try to consume 25 grams of fiber per day, and men should get 38 grams, according to the Cleveland Clinic, and both should drink plenty of water, too. Many kinds of fresh fruits, vegetables, and whole grains contain fiber, says Stahl. “Things like prunes can sometimes get the GI system moving for many patients,” she adds. Although there isn’t a specific diet for people with PD, the foods that Stahl advocates are staples of a Mediterranean-type diet, which is the diet recommended by the Parkinson’s Foundation. “If the constipation is more severe, sometimes an over-the-counter medication or even a prescription medication may be needed, though this is the minority of cases. The patient may be referred to a GI doctor if the problem is severe enough,” says Stahl.
