As most areas in the UK ease out of lockdown, and others enter into it again, finding a ‘new normal’ can be stressful and challenging, particularly for those with Parkinson’s. Following a ‘Life After Lockdown’ webinar with Parkinson’s Concierge, we hope that these tips on meditation and nutrition will help you to regain some control in this time of uncertainty.

Getting Back To Doing The Things You Enjoy

Parkinson’s Nurse Consultant, Dr Annette Hand, reminds us that as things begin to change yet again, it’s about taking control; “stay active, meet loved ones, get out there and do what you want to do”. We know that Parkinson’s affects the levels of dopamine in the brain, which impacts upon how you cope with stress and anxiety. Dr Hand therefore recommends that whilst it’s important to start getting back to ‘normal’ and doing the things you enjoy, you should plan and consider how you will do this. “It’s about baby steps”, she says, “taking things at a pace that you can cope with and using strategies to help you with it; anything that can help you come to terms with what the ‘new normal’ is”.

If you are looking for some new activities in your area, you can enter your postcode on the Parkinson’s UK website and view a range of services that are opening up again.

Meditation Creates Space Between You And Worry

With the worries of COVID-19, Parkinson’s, and everyday life mounting during the day, many people understandably have troubled sleep. Gillian Ward, a meditation practitioner, says that although we don’t quite understand the science behind it, those who meditate always report an increase in energy during the day and a more restful sleep at night. She tells us that even in this tricky time, where we’ve all had to find new routines, easy meditation techniques are helping people to improve their sleep. She says that it is a gentle experience but can be very powerful, providing the opportunity to step away from everything that may be going on.

In addition to sleep, Gillian tells us that meditation is also beneficial for coping with pain. “When we are in pain, we often cut off from that area and it becomes even more tense. We hold it in tension and cut off the blood to it, we don’t breathe into the area. So, meditation is about undoing that and welcoming that part of the body back. I encourage people to notice areas of tension and revisit those areas, giving it some love by simply breathing. You find that the more you just let go and release into that area, the tension dissipates.” She tells us that this comes with practice, sitting somewhere comfortable so that you are not distracted by the pain, and being mindful of your body and breathing.

While some people may not be keen on the idea of sitting still in a meditation class, Gillian reminds us that it is possible to meditate anywhere. You simply need to focus on an ‘anchor’; your breathing, or one of your senses, and pay attention mindfully to what you are doing and how you are doing it. She explains that this is easier to do if you have already been to a meditation class so that you know how to realise you are distracted and come back to your anchor. After this, you can meditate anywhere; watch the clouds in the sky, the rustling of the trees, the waves on the beach or even the people walking past. Simply “pay attention to the present moment and don’t wander off into your thoughts”. The Parkinson’s UK website has a toolkit for practising mindfulness, including a 15 minute mindfulness audio session.

Regain Control Through Monitoring Your Food Intake

Dietitian Richelle Flanagan tells us that, as a person with Parkinson’s herself, she knows it’s natural to want to look for answers to control our disease. One area that we can control is the food that we put into our bodies. This is something that Mark, a person with Parkinson’s, has been aware of for a few years now; he treats his disease in a holistic way and is conscious of the effects of his activity levels, mood, and what he eats. Mark believes that Parkinson’s should be seen as a gut-based disease, as everything that goes into your stomach then travels up to your brain, and “if your gut can’t deal with it properly, it’s going to fuel your brain with the wrong stuff”. Richelle agrees, expressing hope that neurogastroenterologists are now coming to the fore.

With regards to which foods should and shouldn’t be eaten if you have Parkinson’s, Richelle recommends looking at the healthy eating guidelines of your country, as the premise is to take in as many nutrients as you need at a baseline. For example, snack foods that are high in sugar should be avoided in general. Additionally, you should avoid refined carbohydrates such as white bread and pasta and opt for wholegrain types.

For someone with Parkinson’s, there will then be other things to bear in mind. People with Parkinson’s may sometimes have insulin resistance, meaning they are unable to metabolise the sugars in food well; you should therefore avoid loading the body with refined sugars. Similarly, be mindful that alcohol can interact with some medications and will dehydrate you. The calcium found in dairy supports bone health, and Richelle recommends that everyone with Parkinson’s have a scan to check their bone health, as they may need calcium supplements. Similarly, vitamin D is important for people with Parkinson’s and supplements may be needed. Omega 3 can be found in oily fish such as salmon and mackerel, which Richelle explains is beneficial for achy joints.

Both Mark and Richelle recommend keeping a food diary to assess which foods affect your symptoms. For example, Richelle notes that protein is important for keeping muscles strong and fatigue at bay, but some people with Parkinson’s may find that their symptoms are worse after eating a high-protein meal, as protein competes with levodopa for the same absorption site in the gut. Not everyone will find this, so keeping a food diary will help you to be aware of which foods you personally should try to limit or eat at different times. As Mark explains, “All your cells in your body need to be fuelled with something and it’s about what you fuel them with – the right thing –  that doesn’t compromise anything that is complicated with Parkinson’s”. Parkinson’s UK has a wealth of information on diet and how making some simple changes may help you manage your symptoms.

Mark adds that once you notice some changes you need to make, “it’s almost like you have to take a big deep breath and say ‘I’m going to make this change and this change is going to be forever’. It takes a while to make that first step”.

Advice For Dealing With Constipation And Parkinson’s

Richelle explains that constipation is a prodromal symptom of Parkinson’s which can get worse over time, as dopamine affects the bowels and impacts upon how quickly the stool passes through the gut. It can also interfere with the absorption of levodopa, worsening Parkinson’s symptoms as the dopamine you need is not able to reach your brain. Constipation is therefore one of the key things that should be checked with every patient, she says, for diagnosis but also on a regular basis to improve symptoms. While neurologists and movement disorder specialists may lack specific knowledge in this area, Richelle recommends speaking to a dietitian to go through your bowel habits and your diet.

The food that Richelle tells us is important for dealing with constipation is fibre. There are two types; insoluble fibre is “nature’s brew”, helping to move the bowels. These are wholegrain foods and cereals. Then there are soluble fibres, which help to provide softness to stools to help it pass more easily. These come from pulses and nuts, as well as fruit and vegetables. Richelle recommends checking food packaging; 6g per 100g is high in fibre. A combination of these two types of fibres is important for healthy bowels, in addition to drinking plenty of fluid.

How Much Water Should You Be Drinking?

The general guideline is to drink between 1,500 and 2,000mls of fluid per day, which equates to around 8 to 10 glasses. However, Richelle says that fluid intake is based on body weight and guidance should be tailored; for example, if you are doing lots of exercise then your requirement would be much higher.

Richelle recommends you take your levodopa with plenty of water, for two reasons. First, many people with Parkinson’s struggle with swallowing, so water ensures the tablet does not stick in your throat. Additionally, levodopa can increase dehydration, so it’s important to increase your fluid intake. She suggests taking your drug with 500ml of water, as this way, if you take it three times a day, you will find you have easily drunk 1,500ml.

While tea and coffee are included in the term ‘fluids’, be mindful that coffee can dehydrate you and that one big shot of real coffee will contain far more caffeine than a cup of instant coffee. Additionally, fizzy drinks and alcohol do not count towards your fluid intake.

Advice For Dealing With Bladder Problems And Parkinson’s

Dr Hand reminds us that it’s also important to drink plenty of fluids to alleviate the bladder issues that Parkinson’s can cause. Common problems include increased frequency of urination or needing to go during the night, as well as incontinence or pain. There may be many reasons a person with Parkinson’s has bladder problems; you may have walking difficulties that affect your ability to reach a toilet in time, movement issues which cause you to struggle with buttons or zips, or difficulties sitting down. If you don’t drink enough, Dr Hand explains that your urine becomes concentrated which irritates the bladder. This causes it to try to release the urine, making you need to go to the toilet more frequently. She recommends looking at the colour of your urine; “it should look like a nice pale white wine”. If your urine is darker this may indicate you need to drink more, but Parkinson’s medication can also discolour your urine, so Dr Hand suggests keeping a check on what it normally looks like.

If you are concerned, Dr Hand urges you to contact your Parkinson’s nurse so that they can assess you and signpost you to the right places. She stresses that it is important to talk about it early if you start to develop problems, as leaving it for longer can make it more difficult to sort out. Parkinson’s UK have a useful page on bladder and bowel problems.

We hope that this information helps you to feel a little more in control in these troubling times; through mindfulness and being aware of the foods you put in your body. Thank you to the speakers and Parkinson’s Concierge for organising this webinar, and to Mark for sharing his story. Our next blog will look at Mark’s experience of taking control over his own Parkinson’s journey.

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