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Managing Constipation in Parkinson’s Disease
Friday May 08, 2015
Constipation is among the most common non-motor symptoms of Parkinson’s disease. It can occur years before diagnosis in some people. This happens when PD affects the autonomic nervous system that guides the movement of the muscles of our gastrointestinal tract, including the colon. The movement, called peristalsis, becomes slowed, so that the stool moves more slowly through the colon.
The task of the colon is to receive watery indigestible residue from the small intestine, then, as the residue moves along, to remove some of the water. Gradually, as it travels through the colon, the residue becomes a soft, bulky stool that is easily passed.
But when we don’t consume enough liquids or fiber, the residue is not as watery. The colon continues removing water, but the stool moves slowly. Too much water is removed, leaving a hard, dry stool that is difficult to pass. This is what we know as constipation.
Prolonged constipation can, in some people, affect medications. PD medications fail to take effect. Then, when a bowel movement does occur, the medications can “kick in” within minutes. But until them, the person may experience prolonged “off time.”
How can constipation be prevented?
When peristalsis is slowed, it becomes more important than ever to pay careful attention to the daily meals. Highly-processed foods, made with refined flour and sugar, have been stripped not only of their natural minerals and vitamins, but of their fiber also. Avoid these highly processed foods. Instead, choose whole-grain breads, crackers, and breakfast cereals. Use honey, maple syrup or stevia for sweeteners rather than foods made with sugar and high-fructose corn syrup.
High-fiber foods
Next, look for foods that are naturally high in fiber. Most vegetables and fruits contain variety of fibers and pectins, all of which are important to our health. Raspberries, pears and apples are among the highest-fiber fruits, while artichokes, green peas, broccoli, leafy greens such as turnip greens and spinach, and sweet potatoes are high-fiber vegetables. Soluble fibers help control blood glucose; insoluble fibers keep the stool soft and bulky. Both may act as a substrate (“food”) for friendly bacteria in the colon.
Whole grains contain complex carbohydrates as well as fiber, and can be a valuable addition to the menu. Whole rye and whole wheat bread, oatmeal porridge, brown rice and barley (preferably unhulled barley which is one of the highest-fiber grains), are excellent every-day foods.
Legumes (dried beans, peas, and lentils), seeds, and nuts are also extremely high in fiber, as well as important sources of minerals such as magnesium, and vitamins such as folate. Legumes should be included in meals at least three or four times a week. Split pea soup, hummus, Cuban black beans, bean salads and casseroles, refried beans are just a tiny fraction of the multiple ways to use and eat beans. If you have a pressure cooker you can cook them yourself and control the salt and flavoring; but canned beans are inexpensive and perfectly good as well. Chia seeds, flaxseeds, sesame seeds, coconut, almonds, and sunflower seeds are all rich in both fiber and healthful fats.
Fiber must have fluids
Next, consider the need of fluid. The fiber particles you eat require water in order to swell up and keep the stool soft. Aim for at least six 8 –ounce servings of fluids each day, about half of which ideally would be plain water. Coffee and tea count, but the caffeine also causes some water loss. When taking medications, take them with an 8-ounce glass of water, rather than just the sip needed to swallow a pill. Other sources of water includes soups, juices, smoothies, a bowl of chopped mixed fruit (fruits and vegetables are naturally high in water content).
Probiotics for gut health
And, last but just as important, consider use of probiotics, to maintain colon health. Although you can purchase gelcaps containing various probiotics a much less expensive way is to eat fermented foods frequently- sauerkraut and kimchee are examples of fermented foods. Alternatively, make your own kefir. Kefir grains are small particles containing a wide variety of both bacteria and yeasts. When placed in milk, coconut milk, or sweetened water, the kefir grains consume the sugars, producing a fluid rich in microorganisms that are needed by the colon. For information and directions on making different kinds of kefir, see:
http://www.culturesforhealth.com/how-to-activate-dehydrated-milk-kefir-grains-video
http://www.wikihowcom/Make-Kefir
A recent study showed that people with PD have an imbalance of microorganisms in the gut; these friendly organisms can also be depleted by use of antibiotics, or a diet deficient in the prebiotic substances they rely on for food. Prebiotics are certain types of fiber-fructo-oligosaccharides and inulins - which are not digested by humans, but pass into the colon and used as food by these friendly organisms. Eating a variety of high-fiber foods will ensure that your colon receives prebiotics for the probiotics to consume.
If you have questions regarding nutrition for Parkinson’s disease, see the National Parkinson Foundation website “Discussion Forums.” There is no cost to join, just a one-time registration, then you can post questions to PD specialists – neurologists, a pharmacist, and a nutritionist (that’s me). I hope we’ll see you there. http://forum.parkinson.org/index.php
Kathrynne is a Registered Dietitian (retired), author of books on nutrition for PD. See:
Kathrynne Holden, MS, RD
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