Ep 6: Food and Parkinson’s Disease: Nutrition, Meal Preparation and the Act of Eating

[00:00:01] Kat Hill: Before I was diagnosed with Parkinson's, I ate a diet that best fit my lifestyle.

[00:00:08] Anna Stoecklein: What we eat is important and decisions about what we put into our bodies are often influenced by the priorities we juggle in our daily lives.

[00:00:17] Kat Hill: With long hours at the hospital, I would grab what was convenient, not necessarily the healthiest foods.

[00:00:27] Anna Stoecklein: In this episode, we're gonna discuss what to eat and what to avoid when you've been given a diagnosis of Parkinson's disease. And we'll share some of the people and resources that can support good dietary decisions.

[00:00:39] Christine Ferguson: One of the things I want to do today is to advocate for people with Parkinson's to connect with a registered dietician.

[00:00:46] Anna Stoecklein: We'll also discuss how to prepare and eat nutritional meals while experiencing motor and non-motor symptoms.

[00:00:52] Kat Hill: Eating with a bowl helps me and a bowl that I can pick up and scoop with my fork, not just skewer with my fork.

[00:01:03] Anna Stoecklein: The Parkinson's disease podcast was created for educational purposes only. It is not a substitute for formal medical advice. Please talk to your qualified healthcare provider for personal medical diagnosis and treatment. Welcome to The Parkinson's Disease Podcast, I'm your host, Anna Stoecklein.

Changing what you eat in the midst of living with a chronic illness can be intimidating, but there are benefits to finding a diet that works well for people with Parkinson's disease.

[00:01:34] Christine Ferguson: There is no one diet that's recommended for Parkinson's disease.

[00:01:39] Anna Stoecklein: This is Christine Ferguson, a registered dietician and researcher at the national center on health, physical activity and disability at the University of Alabama.

[00:01:49] Christine Ferguson: There are two diet patterns that show promise for people with Parkinson's, one of which being the Mediterranean diet. There have been a lot of research showing that following a Mediterranean diet can be helpful in not only reducing a person's risk of Parkinson's, but also potentially slowing the progression of the disease.

[00:02:10] Kat Hill: The Mediterranean diet is probably the diet that I follow most closely.

[00:02:16] Anna Stoecklein: This is Kat Hill, a person living with Parkinson's, who we've heard from throughout the series.

[00:02:22] Kat Hill: I wanted to minimize anything that might be contributing to my Parkinson's disease or anything else that was making me feel not great.

[00:02:34] Anna Stoecklein: This diet is a popular recommendation for people with Parkinson's.

[00:02:38] Christine Ferguson: It's characterized by high fish intake, whole grains, lots of vegetables and fruit, and it's mostly a plant based diet. They do allow red wine intake, they do allow some soft cheeses.

[00:02:53] Kat Hill: I don't follow a strict diet. I do still eat dairy, but very limited amounts. So a lot of things like nuts, beans, lots of vegetables, definitely some fruits, but not lots and lots of fruit. Usually the fruit is paired with some proteins.

[00:03:15] Anna Stoecklein: However, adopting a new diet like the Mediterranean diet, can be hard and expensive.

[00:03:22] Christine Ferguson: The foods that I recommended aren't necessarily as accessible here in the US. So, depending on where you live, if you live more inland fish is gonna be really expensive. So if they recommend you eat fish at least four to five times per week, that can get really costly.

[00:03:39] Kat Hill: There may be parts of the Mediterranean diet, either that you don't like, you cannot tolerate, or that really don't jive with how you feel, and that's okay. I think that if you don't like one diet or expert, try a different one and you might have to change what works for you.

[00:04:02] Anna Stoecklein: But there's also a newer diet that's a hybrid of the Mediterranean diet. It's called the MIND diet. The MIND diet combines the Mediterranean diet with portions of the DASH diet. While the Mediterranean diet has been shown to support brain health, the dash diet is designed to help treat or prevent high blood pressure. The mind diet spelled M I N D stands for Mediterranean-DASH Intervention for Neurodegenerative Delay, and it was created to help slow the loss of brain function that can happen as we age.

[00:04:35] Christine Ferguson: The MIND diet is a little bit easier to follow. Dark green leafy vegetables are recommended almost every day. So this will be like your spinach, your kale, your collard, your bok choy. The fish intake is only once a week and it also highlights nuts, seeds, beans, berries.

[00:04:55] Anna Stoecklein: There are also specific foods that should be avoided as part of the MIND diet.

[00:05:01] Christine Ferguson: So really limiting intakes of cheese, processed sugary foods, desserts like pies, pastries, other sources of saturated fat, which is found mostly in animal products.

[00:05:16] Kat Hill: That's not to say that I never eat a hamburger and french fries because that would be a flat out lie, but it is not my go-to, it's more a treat.

[00:05:27] Anna Stoecklein: Just like exercise, dieticians advise people with Parkinson's to make small changes that they can keep up consistently.

[00:05:34] Christine Ferguson: What I usually tell people is just be a little more conscious and reflective on what you're eating now. Any incremental changes that you can make to that diet is going to be helpful.

[00:05:47] Anna Stoecklein: Try to remember, it's better to make whatever small changes you can rather than none at all.

[00:05:53] Kat Hill: I know that I may not feel a hundred percent after that hamburger, but in general, I find that moderation with those things keeps me pretty healthy.

[00:06:04] Anna Stoecklein: So why are the MIND and the Mediterranean diet suggested?

[00:06:09] Christine Ferguson: The reason why these two diets are really popular is because they emphasize high intakes of vitamin E, vitamin B12 and folate.

[00:06:19] Anna Stoecklein: And the fruits and vegetables recommended are also high in antioxidants. Antioxidants help protect your cells against substances, which may play a role in heart disease, cancer, and other conditions.

[00:06:32] Christine Ferguson: So they're really going to stave off that chronic low grade inflammation that leads to neurodegeneration.

[00:06:39] Anna Stoecklein: If you'd like to learn more about which foods provide the most antioxidants, head to healthunmuted.com to find a link to the Michael J. Fox Foundation diet PDF complete with a shopping list and meal ideas and reviewed by today's guest Christine Ferguson.
Parkinson's disease can impact the way the body breaks down food. So symptoms like constipation can be common. Kat Hill has been addressing her constipation through a number of small changes.

[00:07:07] Kat Hill: I think there's probably three components that I find really help keep things moving along regularly. Exercise, lots of water intake and lots of fiber in my diet. If I'm not doing that consistently for a couple of days, it doesn't take me long to then suffer some constipation.

[00:07:32] Anna Stoecklein: One way to help resolve constipation is to get fiber from lots of different sources, such as vegetables, fruits, and whole grains.

[00:07:40] Christine Ferguson: Really the key is variety here, trying to get your fiber from a lot of different sources. So whole grains include like brown rice, whole wheat, all of those grains that aren't refined.

[00:07:52] Anna Stoecklein: And if you're wondering how to tell which foods have whole grains and which are refined, here's an easy way to tell.

[00:07:58] Christine Ferguson: So if you look on your bread right now, or like your pasta at home, if the first ingredient says like enriched wheat, then that's not a whole grain.

[00:08:09] Anna Stoecklein: It's important to increase fiber slowly to avoid making constipation worse.

[00:08:14] Christine Ferguson: If you're going to increase your fiber, it's good to know about how much you're consuming now. You want to get to at least 25 grams per day, but you cannot make a big jump overnight or else you're going to make your current problem even worse. It needs to be paired with an increase in fluid intake, preferably water intake.

[00:08:34] Anna Stoecklein: As well as drinking enough water, you can increase your fluids by having some warm drinks, like tea or coffee.

[00:08:41] Christine Ferguson: Just be conscious of caffeine intake. Caffeine can actually help stimulate things, but some people don't wanna have too much caffeine and if that's the case, then do a warm decaf coffee.

[00:08:54] Kat Hill: I still do drink caffeine and I will occasionally have an iced black tea at lunchtime in the summer. I have lots of herbal teas that I may drink, especially on a cold night.

[00:09:07] Anna Stoecklein: You can also try eating foods that contain prebiotics and probiotics to improve gastric symptoms like constipation.

[00:09:14] Christine Ferguson: Probiotics are the good healthy bacteria that we believe can really support your gut health and it can really help metabolize certain foods. Natural sources of probiotics are going to be your fermented foods, things like Greek yogurt, kimchi, kefir, sauerkraut.

[00:09:34] Anna Stoecklein: While probiotics contain this healthy bacteria that's good for gut health, prebiotics act as the food for that good bacteria and can be found in a lot of foods, including the fruits, vegetables, and whole grains, we've already heard about in the MIND and Mediterranean diets. In addition to constipation, another digestive system challenge people with Parkinson's can face is GERD or gastro esophageal reflux disease. Mayo Clinic describes GERD as occurring when stomach acid frequently flows back into the tube that connects the mouth to the stomach. It can create a sour taste or produce a bitter liquid in your mouth accompanied by heartburn or chest pains.

[00:10:16] Kat Hill: I was having regular GERD, gastro esophageal reflux and would treat it intermittently with medicines. It has gone a hundred percent away since really focusing on diet, and I'm shocked by that.

[00:10:34] Christine Ferguson: When you eat certain foods, it can aggravate that. It's hard, especially when someone's dealing with multiple symptoms at once, and sometimes the recommendations may completely contradict each other. That's why one of the things I want to do today is to advocate for people with Parkinson's to connect with a registered dietician, cause that's their job to help navigate all those conflicting recommendations.

[00:11:00] Anna Stoecklein: You're listening to the Parkinson's Disease Podcast, part of the Health UNMUTED audio library. Please like, subscribe or follow this series on your favorite podcast player to stay aware of all future episode releases and check out the other mini series that are available too.
So far, we've talked about some of the changes to food and nutrition that can benefit people with Parkinson's disease, as well as some of the symptoms that can be experienced. Next, let's talk about food preparation. Many people with Parkinson's experience motor symptoms that can affect their ability to cook or even shop for food. Dr. Mathur, a person living with Parkinson's we've met in earlier episodes struggles with making food if she's in the off time of her medication. We've talked about off time in a previous episode and it refers to the time that the medications start to wear off.

[00:11:53] Dr. Soania Mathur: I find stirring very difficult if I'm off, I find flipping things very difficult if I'm off, I find cutting things with knives very difficult if I'm off. So, those are some things I've had to adjust to.

[00:12:04] Anna Stoecklein: There are a lot of adaptive kitchen tools available to make preparing food easier, such as chopping boards with buffers to prevent food slipping and automatic stirring spoons. Using a food processor to chop ingredients can be useful, too.

[00:12:17] Kat Hill: I simply can't safely chop carrots anymore, but I can buy a bag of shredded carrots. I can buy lettuce, that's already washed and prepared. I can even buy pre-cooked hard boiled eggs that are peeled.

[00:12:37] Anna Stoecklein: There are also other shortcuts you can use to make eating nutritious meals, less effort and more affordable.

[00:12:43] Christine Ferguson: Whenever you do buy canned foods, if it's vegetables, it needs to be those low salt alternatives. For fruit it needs to be packed in its own juice or in water with no added sugar.

[00:12:57] Anna Stoecklein: Once you have prepared your food, eating, it can present some new problems.

[00:13:01] Kat Hill: I need to be cautious about talking and eating at the same time. The times that I've gotten into trouble, choking, has been when I'm trying to do both at once. And because I eat a lot of salad and fresh vegetables, I'm also very aware that I need to chew things thoroughly before trying to swallow them. It takes more effort in the swallowing.

[00:13:30] Anna Stoecklein: In the next episode, we'll learn more about issues with swallowing and hear from a speech and language pathologist. For now let's talk about ways to make feeding yourself easier if you're living with Parkinson's disease and experiencing tremors.

[00:13:45] Dr. Brandy Archie: So when you have tremors in your arms, it can make everything that you do with your hands a lot more tricky.

[00:13:51] Anna Stoecklein: This is Dr. Archie, an occupational therapist. She gave us tips on accessible home changes on a previous episode and she's back to explain how eating can be made easier, too.

[00:14:02] Dr. Brandy Archie: And so the first thing that people complain about is difficulty with self feeding. And so if you're trying to pick something up from your plate and bring it to your mouth, and your hand is shaking from point A to point B, you might end up with like two peas left in your spoon and you had a whole spoon full.

[00:14:19] Anna Stoecklein: But there are small adjustments that might help.

[00:14:22] Dr. Brandy Archie: First thing is positioning. So we want you to sit in a nice sturdy straight back chair that has armrest and at a table that's also nice and sturdy, because the more support you can give your core, the less your tremors will affect you.

[00:14:36] Kat Hill: Eating with a bowl helps me and a bowl that I can pick up and scoop with my fork, not just skewer with my fork. That's how I've solved some of the manual dexterity pieces.

[00:14:54] Anna Stoecklein: At this point, you're also gonna need to disregard those table manners you were taught as a child.

[00:15:00] Dr. Brandy Archie: And you wanna put your arms on the table, I know that's rude, but your arms need some support so that the only thing that's really moving is from the elbow down. And then start with using a spoon instead of using a fork. If you can use a big wide soup spoon, that might be enough to solve your problem. We might recommend a swivel spoon where the end of the spoon is also shaking opposite of what your shaking is doing.

[00:15:25] Anna Stoecklein: A swivel spoon has a built in mechanism that allows the spoon to stay level and prevent food from spilling when it's not held at the ideal angle.

[00:15:33] Dr. Brandy Archie: And so it's moving as you're moving and the peas are staying put, so that's a simple solution there. And then you can upgrade that to a more automatic device like the Liftware Steady. Instead of just swinging back and forth it also can go up and down so that by the time the food gets to your mouth, there's still some food on your utensil.

[00:15:52] Anna Stoecklein: The Liftware Steady is one of the many different tools that are available to help with eating that will link to in the show notes. There are also multipurpose adaptive tools that will help with a lot of household activities.

[00:16:04] Dr. Brandy Archie: You also might consider something like adding weights to your wrists and they make these weighted bracelets now that don't look like your normal exercise weights that you would put on your wrist, although they will both work just as fine, but I know that the extra weight on your wrist can sometimes help weight down your tremors so that they're not as impactful for the everyday things that you're doing.

[00:16:27] Anna Stoecklein: Interested in learning more? Let's hear about some resources that can help you do just that. If you'd like to learn more about nutrition, diet, food preparation, and eating tips for people with Parkinson's disease, head to healthunmuted.com to find a full list of resources, including a PDF guide from the Michael J. Fox Foundation reviewed by today's guest, Christine Ferguson, and links to some adaptive tools that can help. There's also a selection of other podcasts that may be helpful as you continue to learn more about this disease such as When Life Gives You Parkinson's. And you can connect with other people who are living well with Parkinson's by joining PD Avengers, a global advocacy group.
In the next episode, we talked to people with Parkinson's about their experiences with voice and communication issues.

[00:17:17] Wayne: I was having trouble with my voice. I was soft voice. My wife was complaining about, she couldn't hear me. And I thought I was speaking loud enough, but I wasn't.

[00:17:27] Anna Stoecklein: We'll also speak to John Dean, a speech and language pathologist who will suggest tips to make speaking and listening a little easier.

[00:17:35] John Dean: There's some basically attention deficits and there's issues with maintaining focus sometimes and that can influence the speech with very common word retrieval problems.

[00:17:46] Anna Stoecklein: Thanks to Christine Ferguson and Dr. Archie for their professional expertise, and to Kat Hill and Dr. Mathur for sharing their personal experiences. This is The Parkinson's Disease Podcast, hosted by me, Anna Stoecklein. This show is a part of the Health UNMUTED audio library by Mission Based Media. To listen and learn more visit healthunmuted.com and follow our show on your favorite podcast player. And be sure to share this podcast with the people in your life.