Eating With Advanced Parkinson’s Disease: Problems and Solutions

Here are some of the most common eating and digestion problems that occur with Parkinson’s disease, and expert solutions on how to address them.

Tremor

But some tremors emerge with activity, says Dr. Stahl. “Those can make tasks like holding utensils difficult. Sometimes we recommend trying to time eating to when medications used to reduce the tremor are working really well; that can make the hands better able to hold objects,” she says.

Loss of Manual Dexterity

Adaptive eating utensils may help people continue to feed themselves, she says. “We do find that using larger utensils that have a bigger grip area can be helpful, so that they aren’t trying to manipulate small spoon handles.”

Swallowing Problems

“One of the first steps we usually take is to have patients see a speech and swallow therapist to evaluate at what point the swallowing issue may be happening. For example, is it at the beginning part of the swallow, or more at the end of the swallow,” she says.

The therapist uses this information to recommend any necessary changes, which can include changing the consistency of food or drink, cutting food into smaller pieces, eating at a slower pace, or making purees out of some foods.

The therapy can help increase swallowing control, which can protect the airway and help prevent aspiration (when food or liquid “goes down the wrong pipe”).

Loss of Smell and Taste

Loss of smell can go hand in hand with loss of taste, she says. “When you have a cold or stuffy nose, you definitely don’t taste as well. For some people with Parkinson’s, this loss can translate into a loss of appetite or interest in eating,” says Stahl.

Unfortunately, there are no medicines or good therapies to address this symptom, she says. “Often we recommend trying to eat foods with as much flavor as possible; that can increase the palatability of the food. Usually, the sense of smell isn’t totally gone — it’s just reduced — and so that can help.”

Spices such as turmeric, oregano, thyme, sage, cinnamon, and cloves, or flavorful sauces like barbecue sauce or chili garlic paste may give food an added boost that makes it more appetizing.

Timing of Protein and Meals With Medications

“The main Parkinson’s medication that we use is called levodopa, and when it’s started, it’s typically a three-times-a-day medication, which can be challenging for people to remember and plan around,” says Stahl.

For people who have more advanced Parkinson’s disease and may be taking the medication three, four, five, or even six times a day, that can get pretty complicated, says Stahl.

If it turns out that the person is sensitive, and they aren’t getting the same benefit from the medicine when taking it with food, particularly protein, that’s when to make changes around the timing of protein, says Stahl.

Constipation

“One way to think about it is that just as walking and other things slow down in a person with Parkinson’s, so does the gastrointestinal (GI) system. There can be a slow transit through the colon and small intestine, and that can certainly cause people to get backed up,” she says.

One of the consequences of constipation may be reduced appetite.

“The first way we would address constipation in someone with Parkinson’s is the same way we would address it in the general population — through diet. For my patients, I recommend they make sure they are consuming enough fiber,” says Stahl.

Many kinds of fresh fruits, vegetables, and whole grains contain fiber, says Stahl. “Things like prunes can sometimes get the GI system moving for many patients,” she adds.

Although there isn’t a specific diet for people with Parkinson’s, the foods that Stahl advocates are staples of a Mediterranean-type diet.

“If the constipation is more severe, sometimes an over-the-counter medication or even a prescription medication may be needed, though this is the minority of cases. The patient may be referred to a GI doctor if the problem is severe enough,” says Stahl.