“Movement & Nutrition” was a webinar hosted by the American Parkinson Disease Association (APDA), as part of its “Let’s Keep Moving with the APDA” series. This webinar featured registered dietitian Rachel Reynolds.  Rachel detailed how a balanced diet is helpful for everyone’s health and especially helpful for people with Parkinson’s Disease (PD). Rachel states that on average, Americans are getting more protein than they actually need. For those with PD, this can be problematic because a higher protein intake can result in needing a higher dose of Sinemet, which can lead to negative side effects.  She recommends eating a balanced diet of whole grains/starches, vegetables, and protein. 

Additionally, Rachel described how specific diets and supplements affect people with PD, and how some PD symptoms can be regulated with diet changes. 

For more information on nutrition, please see this Stanford Parkinson’s Community Outreach webpage.

The webinar recording can be found on the APDA’s YouTube channel here.

Please see below for notes on the February 25th webinar.

Regards, 

– Joëlle Kuehn

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“Let’s Keep Moving with the APDA: Movement & Nutrition”

Speaker: Rachel Reynolds, MS, RD, LDN, Sargent Choice Nutrition Center, Boston, Massachusetts

Host: American Parkinson Disease Association (APDA) 

Webinar Date: February 25, 2021 

Summary by Joëlle Kuehn, Stanford Parkinson’s Community Outreach

Parkinson’s Disease Nutrition:

• No one specific diet for PD or the treatment of PD
• But nutrition does play a very important role in overall health
• Adequate and balanced nutrition does support some PD symptoms regarding health, strength, digestion, medication absorption and certain non-PD symptoms
• Balanced eating pattern: whole grains, veggies, fruit, dairy or dairy alternatives, lean protein sources, heart-healthy oils

Simple “Meal Planning 1-2-3”:

Balanced meals that contain a health-promoting food from each category below is a good start to supporting your active lifestyle:

1. Whole grains & starches
2. Vegetables & fruits
3. Lean protein & dairy/dairy alternatives

For each meal, have 1 + 2 + 3

Add additional flavor and prepare food with heart-healthy fats

Is an easy way to start planning meals

Whole Grains and Starches:

• Provide carbohydrates (CHO) which provide energy and fuel muscles in activity
• Brain is normally completely dependent on CHO
• Contain fiber to support digestive health
• Faster stomach emptying time than proteins or fats
• Examples: 
  • Whole grain: whole wheat (bread, pasta, crackers, cereal), oatmeal, brown or wild rice, popcorn, quinoa
  • Starchy vegetables: sweet potatoes, potatoes, corn, winter squash, plantains

Vegetables & Fruits:

• Provide carbohydrate, fiber and water
  • Fruit has more carbohydrates, so is better as a pre-exercise snack
• Provide essential vitamins & minerals, antioxidants and other beneficial plant chemicals
• Variety is key
• Examples:
  • Vegetables: Asparagus, beets, broccoli, brussel sprouts, bell peppers, carrots, celery, cucumbers, eggplant, green beans, leafy greens, mushrooms, onions, summer squash, tomatoes, zucchini
  • Fruit: apples, apricots, bananas, blueberries, cantaloupe, clementines, cherries, grapes, honeydew melon, mangoes, oranges, peaches, pears, pineapple, plums, raspberries, strawberries, watermelon

Protein Foods:

• Building blocks of cells, essential for muscle repair and build strength and general health
• Most people get more than they need and would benefit from choosing more plant sources
• Plant protein is usually better because they have extra benefits 
• In PD, increasing protein intake is not a goal
• Slower stomach emptying
• Examples:
  • Lean animal proteins: chicken/turkey breast, fish, shellfish, eggs, dairy
  • Plant proteins: Beans, legumes, nuts/seeds, nut butter, hummus, tofu, soy milk

Variety is key!!

If starting or increasing an exercise program, should you change your nutrition?

• If you are doing more physical activity, you use up for energy and need to eat more
• Increase amount of food
• Have something based in carbs before physical activity can be helpful to make sure they have enough energy before exercise

Supplements for people with PD:

• Specific supplements are tricky
• Often a multivitamin that is age and gender appropriate is recommended
• If there are other diagnosis, or vitamin deficiencies, they may need to supplement there under physician supervision
• There isn’t consistent evidence saying there are any supplements that are extra for PD
• Be cautious about supplements because they can interfere with medications and can worsen conditions (ex. Supplements that claim to help brain function)
• Most people get the vitamins they need from food, so that is the first place to start

Is it necessary to have more protein to exercise? Is it good to have a protein shake to build muscle or can it be bad if you take Sinemet?

• Initially protein we get from food competes with certain medications, so it is something we need to consider if someone is on medications
• Most people are getting more protein that they need, and with physical activity the goal is to get enough protein to support building muscle and repairing muscle, but not that they are getting excess
• When people with PD are having too much protein, the dosage of Sinemet will go up, which can be problematic for side effects

Keto diet and PD – or concerns for people with PD for weight loss goals:

• Keto diet is focused on high fat, low carb, high protein
• Potentially a lot of concerns such as excessive protein
• Protein and fat empty slower from the stomach
• A common concern for people with PD is the delayed stomach emptying, so it would make it worse and could be more challenging in terms of digestion
• Reducing carbohydrates and vegetables can cause fiber intake to go down, leading to people experiencing constipation and other gastrointestinal symptoms
• Note: Not everyone with PD needs to restrict protein, just that most people in general get more than they need in general
  • Not restriction, just not getting more than they need

If exercise is uncomfortable because of constipation:

• Most common gastrointestinal symptom that people with PD will report, in general, what can be helpful with people with constipation is people get the recommended amount of fiber they need in a day
  • Women: 25g of fiber/day
  • Men: 38g of fiber/day
  • Average American only gets 15
• Good to increase fiber slowly and also increasing fluids (6-8 cups a day, more with activity)
• Small frequent meals can also help with constipation
• Before physical activity – low fiber foods and then the rest of the day eat high fiber foods

Is a whole-food plant focused diet more helpful?

• For people with PD, plant foods are beneficial for a lot of reasons
• Provide fiber, antioxidants and good for general health
• Plant sources of protein are not absorbed as completely as animal sources which is helpful because they have a better carb to protein ratio 
• Takes some planning to make sure they are enough protein, but it can be helpful

How to know you are getting enough calories, and PD and lack of calories:

• Some people with PD may not eat enough and may be disinterested in food and eat less
• Encouraging exercise is hard because they may not have enough energy
• If not taking in enough, people do feel like they have less energy
• Body weight challenges are common in people with PD
• Often people find weight loss prior to clinical diagnosis
• During the disease, involuntary movements or changes to muscle tone can cause more calories to be used
• Adding a couple more eating occasions during the day can be helpful compared to eating bigger meals
• Small frequent meals can be helpful, less overwhelming when smaller amounts of food
• Including softer foods or alternating food and liquids can help people eat more compared to food that may take more chewing or cutting

Tips for easy/efficient foods that make eating easier and reduce time it takes to eat/cut:

• Sources of fat are more dense with calories
• Might take large amounts of food for the same amount of calories if it is low fat
• Add a small amount of heart-healthy source of fat to a meal can help add calories
  • Nuts, seeds, olive oil, salad dressing
• Only need to add a little bit
• Whole grains and starches tend to be less filling, so easier to add those foods to what they are eating, good to eat those rather than meat which can be more filling and cause someone to eat less
• Drinking fluids are helpful
• Drinking supplements that are low protein are can be helpful 

Any benefit to grass fed/organic meat?

• In red meat, there is a difference in general health
• Leaner meat vs higher fat cut of meat makes a difference
  • Leaner source is more health-promoting in general
• Be mindful in terms of general protein intake – not getting too much
• Grass-fed specifically changes the profile of the fats that are in the meat, but it is varied 
  • May have more heart healthy fat and less saturated fats, but there are a lot of other considerations about the meat someone is choosing outside of grass-fed vs. non-grass-fed (most importantly not getting too much protein)

Resources for finding recipes or interesting ways to bring more vegetables or fruits into your diet:

• Everyone is unique in terms of what they like for recipes so it is hard to give them one place to go to
• Ways to bring more fruits and vegetables into foods you are already eating
  • Don’t have to find a whole new recipe
  • Sometimes it’s something you already make
    • Ex. casserole but adding more vegetables
    • Ex. pasta dish with vegetables as part of the sauce 
  • Easier to adapt because it isn’t a whole extra thing you are doing
• If have a microwave, there are easy and fast ways to cook vegetables in the microwave