Parkinson's disease - Lifestyle Changes

Lifestyle Changes:

Dietary Factors

No special diets or natural foods have been shown to slow down the progression of Parkinson's disease, but there are some dietary recommendations.

Protein. High levels of proteins may affect how much levodopa can reach the brain and may, therefore, reduce the drug's effectiveness. Avoiding protein altogether is not the solution, since malnutrition can result. Most doctors recommend trying to maintain a carbohydrate-to-protein ratio of 7:1 throughout the day. This may be difficult to calculate, and some doctors recommend simply keeping proteins to 12% of total daily calories.

Good control of protein intake may help minimize fluctuations and wearing-off and may allow some patients to reduce their daily levodopa dosage.

Fruits and Vegetables and Increasing Fiber. Eating whole grains, fresh fruits, and vegetables is the best approach for any healthy life. A diet rich in fruits and vegetables may help protect nerve cell function. Many of these foods are also often rich in fiber, which is particularly important for helping to prevent constipation.

Dietary fiber is the part of food that is not affected by the digestive process in the body. Only a small amount of fiber is metabolized in the stomach and intestine, the rest is passed through the gastrointestinal tract and makes up a part of the stool. There are two types of dietary fiber, soluble and insoluble. Soluble fiber retains water and turns to gel during digestion. It also slows digestion and nutrient absorption from the stomach and intestine. Soluble fiber is found in foods such as oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables. Insoluble fiber appears to speed the passage of foods through the stomach and intestines and adds bulk to the stool. It is found in foods such as wheat bran, vegetables, and whole grains. Fiber is very important to a healthy diet and can be a helpful aid in weight management. One of the best sources of fiber comes from legumes, the group of food containing dried peas and beans.

People whose diets have been low in fiber should increase it gradually. It is best to obtain dietary fiber, soluble or insoluble, in the natural form of whole grains, nuts, legumes, fruits, and vegetables. If it proves difficult to do so, psyllium, (found in products such as Metamucil), is an excellent soluble fiber supplement (Metamucil, Fiberall, Perdiem Fiber). Drinking lots of fluids is particularly important in preventing constipation.

Herbs and Supplements

Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Always check with your doctor before using any herbal remedies or dietary supplements.

The following dietary supplements are being studied for treatment of Parkinson's disease:

• Creatine. Creatine is a nutritional supplement that is sometimes used to improve exercise performance. In 2007, the U.S. National Institutes of Health launched a large-scale clinical trial to study whether creatine can slow the progression of Parkinsonâ ' s disease. The trial will enroll patients who have been diagnosed with PD within the last 5 years and who have received levodopa therapy for no more than 2 years.
• Coenzyme Q10 (Ubiquinone). Coenzyme Q10 (also called ubiquinone) is an antioxidant being studied for the treatment of Parkinson's disease. This enzyme is important for cellular energy, which may be impaired in PD. However, a high-quality study was unable to demonstrate a benefit for low dosages of this dietary supplement. Researchers are still investigating whether larger doses given over a long period of time may benefit some patients.

Rehabilitation Therapies

Exercise is an important component of rehabilitation. Physical therapy may help with physical function and quality of life. It usually includes active and passive exercise, gait training, and practice in normal activities. To date, no specific exercise approach has been proven to be better than others.

Exercise Programs. Exercise programs are defined as passive or active.

• Passive exercise, mostly stretching and manipulation of muscles by a physical therapist, is aimed at preventing muscles from shortening. A passive exercise program that begins with slow and gentle exercises and becomes progressively more intense may improve mobility in patients with early and mid-stage Parkinson's disease.
• Active exercises are used to help range-of-motion, coordination, and speed. Patients should continually make efforts to practice movement, even simple ones, such as marching in place, making circular arm movements, and raising the legs up and down while sitting. Patients who enjoy sports or the use of exercise equipment should continue with these activities even if their skills diminish, assuming there are no other medical conditions that would prevent participation.

Gait Training. Practicing new methods for standing, walking, and turning may help retain balance. The following tips may be helpful:

• Take large steps when walking forward, raising the toes at the forward step, and hitting the ground with the heel.
• Take small steps while turning.
• When walking or turning, have the legs 12 - 15 inches apart to provide a wide base.
• Do not wear rubber or crepe-soled shoes because they grip the floor and may cause the patient to fall forward.
• Using devices that keep a rhythmic beat, such a metronome (a simple device used by musicians to keep time), may help patients to walk faster and take longer steps.

Reducing Muscle Freezing. The patient should practice regular daily activities that simplify actions and reduce the incidence of muscle freezing. Most often, freezing occurs when a patient begins to move or is presented with an obstacle. The following tips may be helpful:

• Rock from side to side.
• If the legs feel frozen, lift the toes. This simple action may free spasm in some cases.
• Hum marching tunes. In fact, music has been shown to help people move and to get out of bed in the morning.
• Divide actions into separate events, which may prevent freezing that occurs from trying to coordinate too many physical operations at one time. For instance, when going through a doorway, approach the door, stop at the door, open it, stop, and then walk through the doorway.
• Simply being touched by another person can sometimes release the patient (although a patient with PD should never be pulled or pushed).

Mental Tasks. Mental training is also helpful. Approaches include:

• Select and learn new hobbies that require finger and hand mobility, such as sewing, carpentry, fishing, or playing cards.
• Practice deep breathing and relaxation exercises. These may help maintain proper speech control, control tremor, and reduce anxiety.
• Both the patient and any caregivers should consider psychological therapy and support for depression and loss of motivation. Support programs and groups are widely available and can be invaluable for the patient and the family.

Speech Therapy. Speech therapy may help those who develop a monotone voice and lose volume, particularly in combination with medications. Therapy is prescribed to help with speech and to evaluate and monitor swallowing.

Adaptive Equipment and Assistive Devices

A number of devices can be helpful for maintaining stability and preventing falls. Examples include:

• Rails installed where the patient needs support in getting up or down, such as along the bed and in the bathroom.
• Chairs with straight backs, firm seats, and arm rests.
• Electric beds or mattresses. Sliding boards are also useful for helping patients slide out of bed.)
• Wheelchairs