Define Management of Parkinson's Disease - Drug, Feeding and Nutritional Care?
There is no cure yet for Parkinson's disease, but its symptoms can be minimized with drug therapy. Levodopa or a precursor of dopamine is used mostly. Once levodopa enters the brain it can be decarboxylated to dopamine thus replenishing the depleted neurolransmitter dopamine. Levodopa may produce gastric symptoms and nausea, which can interfere with food intake. For many patients these symptoms are mild and tolerance to nausea does develop. The large amino acids generated from metabolic breakdown of proteins can inhibit the absorption of levodopa and hence is best to have it 1 hour before meals. Very large protein meals can reduce the effect of levodopa, hence managing manipulating the proteins (intake) well can give a better performance in patients. For example patient wishing to remain in an optimum state of activity could benefit from redistributing the protein. Day time restriction of dietary protein-10 g or less upto 5 pm has been shown to improve the efficacy of levodapa. After 5 pm the remaining day's protein requirement can be consumed. This way the patient can have adequate performance of day time activities.
Hence from our discussion above, it is evident that nutrient-drug interaction is an important aspect that we need to consider in the nutritional management of Parkinson's disease. We have already touched on this aspect. Weight loss is also an occasional problem with patients. This could be due to increased calorie needs resulting from involuntary movements, difficulty in feeding, nausea, medicine related factors, dementia, depression and dysphagia could be causative factors. Constipation is also a problem in Parkinson's disease patients due to low grade autonomic function or medication that may contribute to constipation. Difficulty in swallowing too can reduce fluid and fibre intake leading to constipation.