“Did you hear about the constipated composer?”
He could not finish the last movement….
If you guessed by now that today’s topic is on the issue of constipation , then you guessed right!
Constipation is very common …especially in our harried, hurried society where attention has shifted from what we eat to how fast we can eat it and to what is cheaper not necessarily healthier! We may very well be on our way to creating a nation of terribly constipated individuals. Even famous people like President Lincoln was said to suffer from this malady.
…you noticed that everything is marching along well with your PD. Your Parkinson’s symptoms appear to be responding well to current medication regimen. You are cruising along but then you begin to notice an increasingly more constipated feeling. You are feeling more prone to nausea, perhaps even started having some vomiting. But, worst suddenly you are beginning to experience fluctuations in your medication response. But, your motor symptoms have not really changed or worsened! The medication does not always kick in as it is supposed to or last as long as it had been. You wonder could these be related? What to do? You have tried everything and still feel uncomfortable, bloated and severely constipated.
Constipation due to its nature of being both an intrinsic part of Parkinson’s just like tremors as well as a result of medication effect, no wonder we all feel as if we are in a losing battle most of the time! Trying
to keep our bowels regular can be exhausting!
Here are a few tips I have employed over the years with my patients, grandmother and myself to try to help with this problem…..
Rule #3: Make daily healthy positive choices to nourish your body, mind and soul to achieve balance and harmony.
But, keep in mind that constipation seems to be the norm rather than the exception when we are dealing with PD. This will eliminate some of the mental stress. Every single Parkinson patient including myself has found themselves in a similar situation at one time or another since their diagnosis. After all constipation is very common in Parkinson’s disease …not only is it one of the risk factors for developing PD but also one of the presenting premotor symptoms of PD which unfortunately only gets worst as PD advances. (According to a study published in Annals of Neurology in July 10 2012, history of chronic constipation appears to double the risk of developing PD!)
First, of all it is imperative that not only you eat a well balanced nutritious diet of all four food groups (I don’t mean ice cream, Oreos, chocolate chip cookies and sodas! if you have a sweet tooth like me! or alternatively “candy, candy canes, candy corn, and syrup” (from movie Elf)).
In fact, you need to increase water- at least 4 8oz glasses a day (in lieu of carbonated or caffeine drinks), fruit and grains intake. Grain recommendations are at least 5 servings per day but make sure that more than 1/2 is whole grain not refined grain
Examples of whole grain. Refined grain
Wild / brown rice White rice
Wheat bread. White bread
Popcorn Flour tortillas
Wheat tortillas. Corn tortillas
Whole wheat pasta/ noodles. Pasta/noodles
Whole wheat cereal / bran cereal. Cornflakes
Also, make sure you add a vitamin B12 to your diet either through fortified cereal or a vitamin B12 sublingual under tongue to ensure absorption! ( bypasses GI tract)
Things that are high in protein are good for increase digestion but may be detrimental in the absorption and delivery of medication giving you a less than optimal dose. This can be particularly crucial if you are in advanced stage of PD or are already experiencing motor fluctuations! However, if you are on NEUPRO patch only as treatment and or are in early stage of disease dietary protein intake usually does not play much of a role in delivery or effect of medication.
Although, I highly recommend dark leafy greens like collards, spinach etc…because high in b12 I would definitely decrease salad consumption especially at night because hard to digest ….
Make sure you drink lots of fluids especially water to cleanse your system and soften your stool and drink milk enriched with calcium and vitamin D. If they have no calcium than they are not considered dairy products ( butters, cream cheese, yogurt). Yogurt, however, can serve as a great source of bacteria (healthy) that promotes digestive motility. At least 2x a week!
Along with eating a nutritious meal you must eat small meals with snacks in between and try to keep a schedule ( just as you do with your medications especially if you have to take meds with food) …do not eat dinner later than 6p.m. if possible to ensure full digestion before bed time.
Then if still having trouble going, I recommend that you add extra fiber in your diet in the form of tablets (can take 2 tabs 3 x a day) or in powder mixed with food or with water whatever your preference and ad a stool softener daily which can also be taken up to 3 pills a day. I usually alternate between stool softener and fiber because I find that most people tend to develop tolerance and soon the effect diminishes!
Subsequently, if getting into serious trouble and doing all of the above and still having trouble going you can get over the counter Miralax (can be taken everyday if needed- however I caution for same reason as mentioned before) …other laxatives can also be beneficial including mag citrate.
If constipation persists time to discuss with your physician ( at this point may be worth while engaging or considering a team of specialist to help guide you…an initial evaluation with a GI specialist, along with a dietary/nutritionist consultant may also be a great investment of time- especially if having persistent abdominal pain or constipation longer than a week!
He or she might prescribe medications like lactulose, or (amitiza) lubiprostone or (Macrogol) laxative polyethylene glycol.
Having a regular exercise regimen will not only help your Parkinson’s motor symptoms, improve fatigue but will also improve bowel motility. This is an another excellent reason to go out walk, swim, bicycle, dance, or whatever makes you happy as long as you are moving and incorporating stretching exercises through out the whole routine.
I guarantee that if you follow these tips, you will not only feel more energized, move better, tolerate meds better but might even lose some weight in process!
Be creative…if you like pancakes but don’t like oatmeal by itself make oatmeal pancakes for breakfast add some nuts and vanilla extract and enjoy the start to a new healthy less constipated you!
Dr. M. De Leon is a retired movement disorder specialist,
PPAC member and research advocate for PDF; Texas state assistant director for PAN (Parkinson’s Action Network).
You can learn more about her work at http://www.facebook.com/defeatparkinsons101
you can also learn more about Parkinson’s disease at http://www.pdf.org or at http://www.wemove.org