Nutri&on & its Role in Parkinson s Disease. By Mandy Murphy, RD January 10, 2013

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1 Nutri&on & its Role in Parkinson s Disease By Mandy Murphy, RD January 10, 2013

2 Objec9ves A=er today, you will be able to: Iden9fy components of a plant based diet & understand how they can serve in PD Plan your meals accordingly to op9mize drug absorp9on & avoid interac9ons Make adjustments in meals & foods consumed to deal with common PD condi9ons Know about alterna9ve nutri9on therapies for trea9ng PD

3 Today s Agenda Plant Based Diet General Lifestyle Recommenda9ons Drug Interac9ons & Food Timing CombaTng Common PD Condi9ons Alterna9ve Treatments for PD Ques9ons (& hopefully answers!)

4 Mandy s Background & Disclaimer What is an Registered Die99an (RD)? Please consult your personal physician before ac9ng on any of the following recommenda9ons. The following recommenda9ons are not intended to replace any of your current treatment plans or medica9ons directed by your personal physician.

5 Today s Agenda Plant Based Diet General Lifestyle Recommenda9ons Drug Interac9ons & Food Timing Common PD Condi9ons Alterna9ve Treatments for PD Ques9ons (& hopefully answers!)

6 Why a plant based diet? Nutrient dense High fiber Easily manipulated to help with chewing/ swallowing difficul9es Naturally lower in protein, higher in complex carbohydrates

7 An& Inflammatory Food Guide Pyramid by Dr. Andrew Weil from drweil.com

8 Base of Vegetables, Fruits, Whole Grains &Legumes Add lots of color to every meal by choosing a variety of fruits & vegetables Beans & len9ls are naturally lower in protein Aim for whole, unprocessed grains

9 What Comes from the Earth

10 Healthy Fats & Proteins Have tyramine & may need to limit if taking certain MAO Inhibitors Healthy fat in modera9on Lower in protein Naturally plant based diet has carbohydrate to protein ra9on ranging from 3:1 to 5:1

11 Finishing off the plate Spice it up! Use ginger, turmeric, garlic, cinnamon Green tea source of an9 oxidants & fluids Dark chocolate with >70% cocoa solids source of flavonoids & may boost serotonin levels.

12 Plant Based Diet General Lifestyle Recommenda&ons Drug Interac9ons & Food Timing Common PD Condi9ons Alterna9ve Treatments for PD Ques9ons (& hopefully answers!)

13 Lifestyle Recommenda9ons Daily gentle exercise & physical ac9vity light hand weights walking Tai chi and/or stretching Maintain healthy weight Drink sufficient fluids Small, frequent meals Avoid/limit: caffeine ( adrenaline), alcohol (disrupts central nervous system), smoking ( incon9nence), sugar & ar9ficial sweeteners, Processed foods

14 Plant Based Diet General Lifestyle Recommenda9ons Drug Interac&ons & Food Timing Common PD Condi9ons Alterna9ve Treatments for PD Ques9ons (& hopefully answers!)

15 Protein & Levodopa (L DOPA) 1. Limit overall protein intake & spread evenly throughout day (0.5 1 gram/ kg bodyweight) 2. Limit protein throughout day with increased amounts of protein at evening meal & before bed 3. High carbohydrate & low protein increase insulin levels, increase transport of amino acids, decrease compe99on for transport

16 Vitamin B6 & Levodopa Pyrodoxine (Vitamin B6) is required for one of enzymes needed for conversion of L dopa to dopamine Diets high in Vitamin B6 may speed conversion of L dopa to dopamine before it reaches brain, reducing amount that actually reaches brain If taking combina9on medica9on (e.g. Sinemet), no risk Supplements of more than 15mg B6 not recommended

Emsam) Tradi9onally, MAOIs interact with tyramine, which can cause hypertensive

17 Monoamine Oxidase Inhibitors (MAOIs) MAO B Inhibitors do not restrict tyramine unless taken in high dosages Rasagiline (Azilect) Selegiline (Deprenyl, Eldepryl, Emsam) Tradi9onally, MAOIs interact with tyramine, which can cause hypertensive reac9ons: Fermented meats or fish, liver Aged cheese Soybean products Red wine & beer Sauerkraut

18 Plant Based Diet General Lifestyle Recommenda9ons Drug Interac9ons & Food Timing Common PD Condi&ons Alterna9ve Treatments for PD Ques9ons (& hopefully answers!)

19 CombaTng Cons9pa9on Good gut bacteria/microflora, and probio9cs unsweetened, plain yogurt Probio9c supplements Sufficient fluid intake Water, unsweetened tea, broth, soups High fiber intake Plant based diet Ground flaxseed Movement and physical ac9vity

Op9mizing Chewing & Swallowing Suck on crushed ice and/or something acidic (small amounts of lemon juice) to s9mulate salivary glands 20 minutes

20 Op9mizing Chewing & Swallowing Suck on crushed ice and/or something acidic (small amounts of lemon juice) to s9mulate salivary glands 20 minutes before ea9ng Try gargling with Alkolol before ea9ng to cut down on mucus produc9on Keep chin pointed down while chewing & swallowing Take bite sized por9ons

trigger foods, such as alcohol, caﬀeine,

21 Avoiding Acid reﬂux Aim for small meals throughout day Avoid ea9ng several hours before laying down Save larger amounts of liquids for between meals Pay apen9on to trigger foods, such as alcohol, caﬀeine, spicy foods, tomatoes, peppermint, chocolate

22 Plant Based Diet General Lifestyle Recommenda9ons Drug Interac9ons & Food Timing Common PD Condi9ons Alterna&ve Treatments for PD Ques9ons (& hopefully answers!)

23 L Dopa Foods Young fava beans Mucuna beans (mucuna pruriens, velvet beans)

placebo controlled 1400 mg IV drip, 10 minutes, 3x/week 2009 trial in 21 pa9ents for 4 weeks

24 Glutathione Powerful an9oxidant & free radical scavenger Allows dopamine to become more effec9ve & increases serotonin Glutathione IV Drip Trial David Perlmuper, MD Double blinded, placebo controlled 1400 mg IV drip, 10 minutes, 3x/week 2009 trial in 21 pa9ents for 4 weeks Foods Asparagus Avocado Cruciferous vegetables (broccoli, Brussel sprouts, cauliflower, cabbage)

circula9on, relaxa9on Reflexology s9mulate blood

25 Other treatments to consider Acupuncture/acupressure improved nerve func9on Lympha&c Massage improved circula9on, relaxa9on Reflexology s9mulate blood flow, strengthen Central Nervous System Medita&on stress reduc9on

26 Supplements* Conenzyme Q10 powerful an9oxidant Vitamin C an9oxidant and free radical scavenger Vitamin D bone health, may alleviate depression Vitamin E an9oxidant, homocysteine reduc9on Essen&al fawy acids (DHA & EPA) heart and brain health Nico&namide adenine dinucleo&de (NADH) improves brain func9on Probio&c op9mal microflora/gut bacteria N acetyl cysteine (NAC) increases levels of glutathione Milk thistle liver detoxifier *Please consult with your personal physician before considering any supplements, altering any treatment plan, or determining appropriate dosage

27 ues&ons?

28 Mandy Murphy, RD contact:

29 References Balch J, Stengler M, Young Balch, R. Parkinson s Disease. Prescrip9on for Natural Cures Holden K. Eat Well, Stay Well with Parkinson s Disease. nutri9onucanlivewith.com Nelms M, Sucher K, Long S. Parkinson s Disease. Nutri9on Therapy and Pathophysiology Peterman Schwarz S. Managing Meal9me Madness. Parkinson s Disease 300 Tips Weil, Dr. Andrew Weil, Drweil.com

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