In late September 2023, the American Parkinson Disease Association (APDA) hosted registered dietitian Jessica Schoeder, RDN, for a presentation on how to eat well with Parkinson’s disease (PD). She shared recommendations for using diet to manage the five most common complications she hears about from people with PD, including constipation, orthostatic hypotension, delayed gastric emptying (also called gastroparesis), weight loss, and balancing medication absorption with eating protein. She gave examples of snack plates and meals for each complication. This webinar was part of the APDA’s “Dr. Gilbert Hosts” series.
A recording of the webinar is available on the APDA’s YouTube channel
You can find resources on nutrition for PD, and some of the complications Jessica mentioned, on the Stanford Parkinson’s website:
She answered numerous questions covering all kinds of topics. My summary of the presentation and question-and-answer session are below.
“Nutrition and Parkinson’s Disease”
Speaker: Jessica Schroeder, RDN
Webinar Host: APDA
Moderator: Rebecca Gilbert, MD, PhD
Webinar Date: September 20, 2023
Summary by: Jordan Dagan, Stanford Parkinson’s Community Outreach
Jessica described the five most common complications she hears about from people with PD, and shared ways they can each be addressed using dietary changes.
Constipation can be made more troublesome by some medications and by lack of movement. Jessica recommends adding fiber to your diet, which can be found in whole grains, fruits and vegetables, and legumes. She says drinking enough water is important for your body to make full use of the fiber in your diet, and that foods containing magnesium can help both dehydration and constipation. No, coffee does NOT count as hydration!
The constipation example snack plate contained roasted chickpeas and edamame, smoked salmon (which contains magnesium), raw bell pepper, carrots, and apples, and whole grain crackers.
Jessica said that eating several small meals throughout the day, rather than two or three large meals, can help stabilize fluctuations in blood pressure. To increase hydration and blood volume, Jessica advised drinking enough water, and making sure you get enough electrolytes. The four major electrolytes are sodium, potassium, calcium, and magnesium. Jessica described these electrolytes as a group of friends who work best together, and emphasized that finding dietary or supplemental sources of all four will provide the best hydration. Hydration is most important in the morning, which is when orthostatic hypotension tends to be the worst.
The orthostatic hypotension example meal was a bowl of turkey and vegetable chili, accompanied by crackers or cornbread. Chilis and other meals made using canned goods have a lot of sodium and other electrolytes.
UNINTENDED WEIGHT LOSS
Eating enough calories can be difficult, so Jessica recommends eating foods that pack many calories into a small volume. This includes foods like nut butters, honey, or maple syrup. Peanut butter also contains beneficial magnesium and sodium, as well as healthy fats. Jessica advised people struggling to keep or gain weight to eat what they enjoy, and to keep their diets simple. Eating several small meals a day, or making a snack plate to munch on, can also make eating feel like a less daunting task.
The plate example for unintended weight loss included a peanut butter and jelly sandwich or tortilla rollup, and a side of fresh fruit.
INTERACTIONS BETWEEN DIETARY PROTEIN AND MEDICATION ABSORPTION
Though dietary protein can interact with medications, Jessica encourages people with PD to focus on the timing of their meals and medications, rather than attempting to remove proteins from their diet. If people don’t have enough protein, they are at greater risk for loss of muscle and large fluctuations in blood sugar, which contributes to the risk of falling and injury. Jessica’s recommended routine for eating protein and taking medication is as follows:
- When you wake up, have some water and take your medicine.
- Wait about 30 minutes, then have breakfast without protein.
- Wait about 90 minutes after you have had food, which gives your medicine time to absorb fully. Then have a second breakfast which includes protein.
- Overall, wait at least 90 minutes after you take your medicine before consuming protein. Wait at least 90 minutes after you eat protein before taking another dose of medicine.
- If you’re struggling to manage the timing of your meals and medications, talk to your doctor, or an occupational therapist.
DELAYED GASTRIC EMPTYING
Delayed gastric emptying, also known as gastroparesis, can be managed by eating small meals throughout the day, rather than two or three large meals. Jessica recommended chewing your food thoroughly, and eating ground meats rather than chunks. Steamed and thoroughly cooked vegetables may also be better than raw vegetables. These may be easier for your stomach to process, and are also easier for those with difficulty swallowing. If you have difficulty cutting up your food, Jessica advised purchasing pre-cut portions of meat.
The example meal for gastroparesis, which would also be beneficial for those with difficulty swallowing, was a pumpkin soup, cottage cheese, and shredded or cubed chicken.
QUESTIONS AND ANSWERS
(17:30) How much water should we be drinking?
Answer: Measure how much water you’re drinking for a couple of days, to get an idea of whether you’re drinking enough water. The eventual goal is about 80 ounces per day. Start small, around 40-60 oz/day, and work your way up from there, drinking about 8 oz more per day. Jessica would like to remind everyone that coffee does NOT count as water!
(19:00) How can we balance hydration with urinary challenges?
Answer: Increase your water intake gradually, and drink water throughout the day rather than all at once.
(20:00) If we’re not getting enough electrolytes, should we try taking a sodium supplement?
Answer: You can use supplements to get electrolytes, though Jessica prefers natural options. Make sure the supplement you use contains all electrolytes, not only sodium. The four electrolytes you’ll need are calcium, magnesium, sodium, and potassium. Jessica would recommend a salt stick tablet.
(21:20) What do you think of meat as a protein source?
Answer: Consuming meat is perfectly okay, if it aligns with your beliefs. Variety and moderation are important, however! Consider eating a variety of poultry and different kinds of red meat. Try increasing your intake of fish, beans, and lentils for alternative sources of protein.
(23:10) How can we get adequate calories if we lack appetite?
Answer: Try increasing your daily exercise, which will stimulate hunger. Have small meals or snacks throughout the day. If you’d like to drink instead, have a meal replacement shake or protein shake.
(24:25) What do you think of eating dairy, as someone with PD? There is conflicting research on dairy consumption associated with development of PD, or worsening of symptoms.
Answer: Jessica said eating all foods is okay, if they are eaten in moderation. She said if you’re not seeing side effects or worsening of symptoms that you notice are clearly associated with eating dairy, eating dairy is probably fine.
Dr. Gilbert added that the association in research literature between dairy consumption and development of Parkinson’s may be an association, but that dairy doesn’t necessarily cause PD or PD symptoms. She added that dairy is an excellent source of calcium for bone health, and that for many people with PD, falls and fractures are a common problem.
(26:50) How bad is sugar?
Answer: Jessica says this depends on whether sugar is being consumed in moderation, and what type of sugar it is. Sugars are always in carbohydrates, but not all carbs contain an excess of sugar. She advised people not to fill their day with sugar, but to not cut it out either. It is essential to enjoy your daily food, and carbohydrates are good for you in moderation!
(28:40) What foods can reduce leg cramps?
Answer: Getting all your electrolytes is important! Jessica frequently hears “eat a banana to get more potassium,” as a treatment for leg cramps, but potassium isn’t always the culprit in cramps. A diet low in magnesium or calcium might be part of the issue. Jessica suggested drinking water with fruit in it, or water with lemon and a bit of sea salt.
(30:00) Should someone struggling with unintended weight loss drink Boost or Ensure supplement drinks?
Answer: Jessica acknowledged that using a supplement drink or meal replacement shake might be the easiest solution available for unintended weight loss. She advised considering what type of supplement is best for your needs; a meal replacement shake will provide different nutrients and calories than a protein shake, for example. Adding protein powder to yogurt or ice cream might help add calories to your diet.
(31:20) What do you think about gluten?
Answer: There is no need to avoid gluten, unless your health symptoms correlate with your gluten intake. If they do correlate, ask your doctor about testing for gluten intolerance or allergy. There may be a specific type of grain you’re sensitive to. Overall, whole grains are more beneficial than processed grains.
(32:35) Can we drink alcohol?
Answer: In moderation, alcohol is fine. Jessica defines moderate alcohol intake as 2-3 drinks per week. She said you need to know how alcohol affects you, and how it interacts with any medications you’re taking. Stay hydrated while you drink, to reduce the risk of falling.
(33:30) Do you recommend any dietary changes to help with sleep?
Answer: Jessica suggests eating throughout the day, rather than having a heavy meal just before bed. This also helps digestion. Overall, eating less than two hours before going to bed may interfere with your sleep, especially if you eat a lot of carbs before bed. Skipping meals can also disrupt your sleep quality.
(35:10) What do you think of specific diets, like the “whole 30” diet?
Answer: Jessica said she understands the appeal of having a specific schedule or set of guidelines to follow, when deciding what to eat. She also understands the appeal of weight loss. However, diets like “whole 30,” or “the blue zones diet” are not made to help individuals. A Mediterranean-style diet is probably the best for those with PD, if a specific style of diet is important to you. Jessica says the goal is balance between major types of foods.
(37:05) What do you think of supplements?
Answer: Jessica prefers to make a personalized plan for each individual’s nutrient needs, but said that a multivitamin can help fill in gaps in your diet if you’re not getting the nutrients you need. Taking a vitamin D supplement is useful for those who aren’t getting much time outside in the sun; this may be helpful for those with limited mobility, or when taken seasonally.
(38:30) Do you have any advice on how to balance Parkinson’s and diabetes?
Answer: When managing diabetes, the key is to keep blood sugars stable. Jessica recommends pairing carbs with protein, which she said can be tricky if you’re also taking dopamine medications. She advised writing out a schedule of your eating, medication, and any blood sugar corrections, so that you can remember what works or doesn’t work for you, and so you can consult your doctor if needed.
(39:40) Are antioxidants good for PD? What foods can we find them in?
Answer: Antioxidants reduce the stress on the body from inflammation, which is helpful for almost everyone. Antioxidants can be found in leafy greens, berries and fruits, pumpkin and other squash; Jessica says “eat the rainbow!”
(41:20) If we have difficulty swallowing, what foods can we eat?
Answer: Ground meats rather than cubed meats, soups, and thoroughly cooked vegetables can all ease swallowing difficulty. Drinking water between bites may wash the food down easier, and adding sauces for flavor or for dipping can moisten food for easier swallowing.
(42:10) How can we use food to support our microbiome? There is conflicting research suggesting the gut microbiome might be altered in people with PD.
Answer: Bloating and constipation can be caused or worsened by an unbalanced gut microbiome. Consider increasing the fiber in your diet, or eating yogurt and fermented foods like kombucha as natural sources of probiotics.
(45:50) Dr. Gilbert added that many research studies attempt to correlate environmental factors or interactions with the development of Parkinson’s symptoms. The research is still ongoing, and an association between two factors does not mean there is a causative relationship.
(44:15) Please review or clarify your recommendations for balancing medication and protein intake.
Answer: Do eat proteins such as meats and dairy! Wait 90 minutes after taking your medication to consume protein, and have your next dose of medicine at least 90 minutes after consuming protein.
(46:45) Is there a difference between sodium and salty foods?
Answer: Sodium is in salty foods. There are also multiple electrolytes that your body needs, besides sodium.
(47:30) What do you think of “ancient grains” such as millet, quinoa, or tiff?
Answer: Jessica said ancient grains aren’t essential, but you can add them to your diet if you’d like to. They tend to be high in fiber and beneficial omega-3 oils.
(48:10) If we have difficulty with motor skills, what tips do you have for prepping food?
Answer: Purchase pre-cut meats and vegetables, or frozen food in steamable bags. Work with your needs and limitations, rather than against them. Ask for help if you need it.
(49:45) What foods can help fight fatigue?
Answer: Eat smaller, more frequent meals. Fatigue also gets worse if you skip meals or eat an excess of carbohydrates. Try to keep your blood sugar steady by eating more proteins, fruits and vegetables.
(51:40) Are there any foods we should avoid if we have Parkinson’s?
Answer: No. Anything can be eaten in moderation. Most of your food should be nourishing, but comfort foods are important for quality of life and mental and emotional health. Having a treat every so often is a good thing!