Kathrynne Holden, M.S., R.D.

Not everyone realizes that water is considered a nutrient. But in reality, it’s quite possibly the most important nutrient of all.Yet, water is so cheap, so plentiful, and so easy to get, that we may take it for granted. We forget all the special things about water that no other drink can match.

Water dissolves the vitamins and minerals weneed. Then blood, which is mostly water, carries them throughout the body.Water also helps lubricate our joints, and acts as a shock absorber inside the eyes and spinal cord. And, when the digestive system changes the food into fuel for the body, a lot of toxins and wastes are produced. Water is the force that carries these wastes out of the body in the breath, the urine, and the fecal matter. Truly, water is a miraculous substance.

Are fluids more important if you haveParkinson’s? Yes, because those with PD are more likely to have constipation.Yet, with PD, there are so many things to think about that I believe the need for fluids often can be forgotten. However, fluids can be one of the most important aspects of dealing with PD.

How does water help constipation? The job of the large intestine, or colon, is to maintain enough water in the stool to keep it soft. But a hard stool is not life-threatening, so the colon has a low priority on water. When there’s not enough water to go around, the colon removes some water from the stool and gives it to other organs – the brain, the kidneys, the bloodstream. The stool becomes dry, hard, and difficult to pass, resulting in constipation. Although constipation has many possible causes, if you don’t drink enough water, constipation is a pretty sure bet.

But if you’re not used to drinking water, start gradually adding a half-glass a day, and work up to 6 to 8 glasses. Your system may take some time to adjust.You could find that you retain water at first, but gradually your body will release the extra fluids and stay at a well-hydrated level.

Urinary tract infections --Another reason to drink plenty of fluids

Bladder and urinary tract infections are common in older adults and people with PD. Why? The thirst sensation is blunted as we age; therefore, we don't feel thirsty, even when we need fluids. Older adults are frequently in a state of mild and prolonged dehydration. This allows bacteria to grow and thrive in the bladder and urinary tract, causing infection.

A large glass of cranberry juice daily, along with at least four (preferably eight) glasses of water, plus any juices or other beverages usually consumed, is a good idea. Cranberry juice can help prevent infections in many cases, and can also help cure them, along with medications. Cranberries contain a substance that makes it difficult for bacteria to adhere to the walls of the bladder and urinary tract.The bacteria are then flushed out by the flow of urine.

Dry mouth, dry eyes, thirst – more reasons why we need fluids

Some people report that they often feel thirsty and sometimes have dry mouth, thick or sticky saliva, and dry eyes. This may be due to anti-Parkinson medications; the anti-cholinergic drugs such as Artane or Cogentin used totreat tremor are particularly known to cause such symptoms. Dry mouth may also be caused by difficulty swallowing, sleeping with the mouth open, or mouth breathing while awake. Be sure you’re drinking plenty of fluids to counteract dry mouth.

Why is dry mouth a problem? Without saliva, bacteria can breed along the gums and cause decay and loss of teeth. Tooth loss may result in the need for dentures, which often don’t fit well or work as well as natural teeth. This sometimes means that food is poorly digested. Dentures can also cause painful sores on the gums, if they don’t fit well.

More on oral health

Other problems that affect dental health may include difficulty brushing, flossing and/or rinsing the mouth due to rigidity of the tongue, jaw and facial muscles. People with PD should discuss good oral care with their dentists. Provide a list of all the medications you use. Your dentist can recommend anartificial lubricant to help keep the mouth moist, if necessary. Also ask whether you need fluoride treatments or rinses.

If you are drinking six to eight glasses of water daily, plus juices and other beverages, yet still feel that your mouth is dry, try sipping water frequently and swishing it around your mouth to keep it moist.You should also report dry mouth to your dentist, who may suggest a fluoride rinse or artificial saliva, or even sugarless chewing gum.

Dry eyes

The automatic blink reflex is diminished in Parkinson’s disease, causing less frequent blinking.This often results in tired, dry, itchy eyes even in a person who drinks plenty of water. Using artificial tears 2-3 times daily, available over-the-counter in pharmacies, is often recommended. Check with your doctor or optometrist to see if this solution might be helpful to relieve dry eyes.

Excessive thirst / no thirst

Feeling very thirsty can be a sign of acute dehydration. Chronic dehydration, on the other hand, doesn’t always cause a feeling of thirst, yet causes many hospitalizations and may even result in death. Chronic mild dehydration, therefore, can be even more dangerous, because it goes unrecognized until it’s too late. Unfortunately, many PD medications can raise the risk for dehydration, both chronic and acute.

Note:The thirst mechanism slows down with age. Unlike the hunger signal that tells us our body needs fuel, thirst awareness may not activate until we’re already dehydrated. Also, older adults are more likely to take medications that change the amounts of sweat and urine produced, including drugs for respiratory conditions, urinary incontinence, diuretics, and PD.

Unless your doctor has ordered a fluid restriction, the best bet is to drink plenty of plain water, a minimum of 4-8 glasses per day. If you drink caffeine containing drinks or alcoholic beverages, be sure to drink extra water.

People with PD have many concerns -- medications and their effects, timing of meals and levodopa, job responsibilities, family concerns, and much more. Sometimes the most basic need of all can be forgotten: the body's need for water.

Signs of dehydration

• Urinary tract infections

• Low back pain

• Mental confusion

• Dizziness

• Fatigue

• Dry tongue, longitudinal furrows in the tongue

• Dry mouth, cracked lips

• Sunken eyes

• Dark urine, infrequent need to urinate

• Difficulty swallowing liquids

• Difficulty speaking

• Upper body weakness

• Weight loss

If you experience dry mouth, dry eyes, or excessive thirst, write down how much water you drink daily, and check to see if you’re drinking enough. If not, try adding half a glass per day until you reach the recommended level.

Kathrynne Holden, M.S., R.D.

Osteoporosis is serious. It can cause fractures of the hip, spine, or wrist, and affects many women over age 60. However, though it’s not as widely known, men – especially men with PD – are also at risk for osteoporosis and fractures. Studies have shown that both men and women with Parkinson’s disease are likely to have lower bone mineral density, and greater incidence of osteoporosis, falls and bonefractures. Recovery from hip fracture takes longer with PD, and many people require long-term care before returning to their own home.

What is osteoporosis?

Osteoporosis is a disease that causes weakened bones. Calcium is removed from bones, leaving tiny holes. The early stage of such bone thinning is called osteopenia; when it progresses too far, it is called osteoporosis, and the risk for fracture is greatly increased.

What are the common risk factors for osteoporosis?

• Age. Bone loss increases with age.

• Post menopausal estrogen loss in women

• Heredity and race: white and Asian women are at greatest risk.

• Long-term use of medications, such as the steroids used to treat asthma and arthritis; some cancer treatments; anticonvulsants; and antacids that contain aluminum

• Diseases that affect hormone levels, such as diabetes, kidney disease, and hyperthyroidism.

• Smoking.

• Excessive alcohol use.

• Low calcium intake.

• Too little physical activity.

An ounce of prevention is worth a pound of cure

Strong, dense bones can withstand the impact of a sudden fall, while weak, brittle bones will fracture. Men and women with PD can do a number of things to prevent osteoporosis. Although we can’t do anything about age and heredity, there are other risk factors that we can control.

• Avoid unplanned weight loss – stay at a healthy weight. Losing too much weight raises the risk for bone fractures. Unplanned weight loss is accompaniedby loss of bone mass as well as muscle and fat. Let your doctor or registered dietitian help determine the best weight for you, and maintain that weight.

• Talk to your doctor:

• If you are a man or woman over age 50• If you are a post menopausal woman

• If you have a family history of osteoporosis

• If you use medications that increase the risk for osteoporosis

• If you believe you have low levels of testosterone (men)

• If you have diabetes, kidney disease, or hyperthyroidism.

Change any unhealthy habits that cause bone thinning, like smoking, excessive alcohol use, and inactivity. Get enough calcium, magnesium, and vitamins D and K.

Calcium — the bone mineral

The latest recommendation for adults age 50 and older is 1200 mg calcium per day.That amount can be found in four glasses of fortified milk or four to six ounces of cheese. But, since these foods are high in protein, they may not be helpful for those using levodopa. In fact, some people have found that dairy foods are more apt than other protein foods to inhibit levodopa absorption.Getting enough calcium can be difficult when you have PD. Here are some recommendations that will help to meet calcium requirements.

• Calcium-fortified orange juice

• Calcium-fortified rice- and soy- milk alternatives for use on cereal, in smoothies, and in many cooked dishes

• Breakfast cereals and other foods fortified with calcium

It may also be necessary to use a calcium supplement. Calcium carbonate is the richest source of calcium, but some people cannot tolerate it. Calcium citrate is often a better choice. Chewable calcium tablets are better absorbed, because they are already broken down when they reach the stomach.

Vitamin D -- for calcium absorption.

Without adequate amounts of vitamin D, calcium cannot be absorbed by the body. If you live in a sunny area, vitamin D is easy to get through about one hour per week outdoors in the sunshine with the face, hands, and arms exposed. Because vitamin D is stored, our bodies can conserve enough D during the summer to last us through the winter.

However, if you live in northern areas or if you mostly stay indoors, you may not get enough vitamin D from sunlight.The current recommendation for vitamin D is 400 IUs daily (ten mcg) for people age fifty and older; and 600 IUs daily (15 mcg) for those over age 70.

Food Sources of Vitamin D:

Fortified foods, such as milk and milk substitutes, milk products, margarine, and cereals

Fatty fish, such as salmon, and fish liver oils

Liver

Eggs

If you think you’re not getting enough vitamin D, check with your doctor or registered dietitian about a vitamin D supplement. Be careful not to take too much, since it’s stored in the tissues and can be toxic in large amounts.

Magnesium is just as important as calcium.

It helps rebuild and strengthen bone. Magnesium also has some effect as a muscle relaxant, so may be beneficial to people with PD who experience muscle rigidity as a primarysymptom.

Broccoli and other dark green vegetables, dried beans and peas, and whole grains are all rich in bone-building magnesium. For adults, the RDA is 420mg per day for men, 320 mg per day for women. Magnesium and calcium are often combined in over-the-counter nutritional supplements.

Don’t forget vitamin K. This nutrient is also important, however, it is not as difficult to get from foods as calcium and vitamin D. The adult requirement for vitamin K is 120 mcg for men and 90 mcg for women. Dark green leafy vegetables such as collards, spinach, and chard; Brussels sprouts, broccoli, cabbage, and lettuce, all provide generous amounts of vitamin K.

Tuesday, November 4, 2008
By GARY BROWN

November is National Alzheimer's Disease Awareness Month, casting a spotlight on a disease that is stealing an increasing number of lives.

"As many as 5 million Americans are living with Alzheimer's disease," notes the Web site for the Alzheimer's Association.

"Alzheimer's destroys brain cells, causing problems with memory, thinking and behavior severe enough to affect work, lifelong hobbies or social life. Alzheimer's gets worse over time, and it is fatal. Today it is the sixth-leading cause of death in the United States."

We don't have to sit and wait for the disease to strike us or our loved ones. Researchers have developed guidelines for healthy living that reduce the risk of developing neurodegenerative diseases such as Alzheimer's and Parkinson's.

The following guidelines were taken from a report — "Environmental Threats to Healthy Aging from Greater Boston Physicians for Social Responsibility and the Science and Environmental Health Network" — that indicated neurodegenerative diseases are not necessarily inevitable.

The report presents science and analysis indicating environmental factors — diet, stress, exercise and exposure to chemicals — "are key drivers in Alzheimer's and Parkinson's diseases."

The report said people can take the following actions to reduce the risks of developing Alzheimer's and Parkinson's:

1. Practice good nutrition from the beginning of life

"Prioritize healthy and nutritious food for children, teenagers, and adults. Consumption of fast food and calorie-dense snacks ... should be reduced or eliminated."

2. Eat lots of fresh fruits and vegetables, especially deep-green and orange vegetables

"Fruits and vegetables provide essential antioxidants, vitamins, and other critical micronutrients."

3. Eat foods high in omega-3s

"Eat fish at least once a week. ... If using fish oil, chose a brand that has been distilled to remove toxicants. Minimize consumption of fish that are high in contaminants such as mercury and PCBs."

4. Avoid routine consumption of sugar

"Table sugar, high fructose corn syrup, maple syrup and honey, and beverages and foods containing them, cause rapid elevations of blood sugar."

5. Consume low-glycemic carbohydrates, such as whole grains and legumes (such as chick peas and lentils)

"Other examples include brown rice, pearled barley, steel-cut oats, rye, buckwheat, fruits, non-starchy vegetables, pasta, winter squashes, and tubers (yams, sweet potatoes)."

6. Modest consumption of alcohol is okay

"Beverages like red wine and green tea contain important antioxidants ... and caffeine may reduce the risk of Parkinson's disease."

7. Avoid food additives, such as aluminum

"Recent evidence suggests that dietary aluminum may increase the risk of Alzheimer's disease. Highest aluminum levels in food have been reported in some pancake and waffle products — including mixes, frozen and restaurant varieties."

8. Reduce exposure to toxicants

"Avoid hazardous exposures to toxicants such as lead and solvents during building and remodeling projects. ... Also eliminate or reduce pesticide use in the home and on lawns and gardens."

9. Increase physical activity

"Walking more each day can improve health, prevent overweight and obesity, and help maintain independence."

10. Increase social activity

"Regular social engagement with others reduces the risk of cognitive decline in later years. Volunteer, get involved in com-munity activities, and stay in touch with family members."

11. Reduce stress

"Many of us are constantly expected to multitask and respond instantly to ever more rapid communications. Try to find even a few minutes a day to relax."

12. Exercise your brain

"Exercising your brain may be beneficial for maintaining healthy cognition. Common sense ways to do this include crossword puzzles and word games, chess, and activities that require critical thinking."_

What is constipation and why does it occur so frequently with Parkinson’s?

Constipation is defined as having fewer than three bowel movements per week. It occurs among many people with PD. Possible reasons include:

1) PD may cause some degeneration of the nerves of the GI tract.These nerves control “peristalsis” – the rhythmic movement of the GI tract, including the colon. When they are affected, peristalsis slows down. Slowed peristalsis of the colon means that the stool moves very slowly, becoming dry and hard

2) Medications used to treat PD (levodopa, dopamine agonists, selegeline, amantadine, anticholinergics, and others) can also cause constipation, again by affecting peristalsis.

3) People with PD often have a craving for sweets, which contribute to constipation by replacing the high-fiber foods that help to soften the stool and speed peristalsis.

4) Very few people drink enough fluids, which are needed to help keep the stool soft and bulky.

Why is constipation a cause for concern? Isn’t it mainly just a nuisance?

At first, constipation may seem more of a nuisance than a real concern. However, there are several concerns, all of which have occurred in some people with PD.

• A person who is frequently constipated, over a long period of time, may develop hemorrhoids, a condition in which part of the tissues lining the anus slip outside, becoming enlarged and painful.

• Another concern is the possibility of bowel impaction, also known as fecalimpaction — a condition where dry, hard feces accumulate in the colon and cannot be passed. Sometimes watery feces may pass around the impaction, as diarrhea, leading the person to believe s/he is not constipated. Bowel impaction can be very painful, and may require hospitalization. In extremecases, surgery may be necessary.

• Still another consideration is that chronic constipation can raise the risk for colorectal cancer.

If constipation is caused by medications or by PD, how can it be controlled?

It’s important to get enough fiber and fluids each day. Besides helping to prevent constipation, fiber can help lower blood pressure and cholesterol, prevent many chronic diseases, and often aids people with diabetes in controlling their blood sugar. Fluids, especially water, work hand-in-hand with fiber to keep the stool bulky.

What does fiber do?

Fiber, along with water, keeps our bowels working smoothly. Insoluble fiber works like a partner with water. Each bit of fiber soaks up water like a little sponge and swells up to many times its size. All these little water-soaked sponges add bulk to the stool, making it soft and easy to pass.They also exercise the muscles of the intestine, so they stay strong and healthy. More frequent bowel movements are often the result.This not only helps prevent constipation, it can also prevent or ease hemorrhoids. These occur when we strain to pass the stool. Fiber may also lower the risk of colon and rectal cancers.

Why can’t I just use laxatives?

Many people prefer laxatives, which are powerful, but work in a different way. Laxatives stimulate the nerve endings of the colon, causing rapid removal of bowel contents. Over time, stimulant laxatives damage the lining of the colon, causing even greater difficulty with constipation.

What sources of fiber are best?

Fiber is found only in plant foods. Foods highest in insoluble fiber are whole grains, cooked dried beans, and fruits and vegetables with edible skins. Wheat bran is an excellent source of insoluble fiber. People who experience constipation should aim for 25 to 35 grams of fiber daily.

If you’re not used to eating whole-grain foods, or apples and potatoes with the skin, it’s best to increase the fiber content gradually. Bloating and gas can occur as the system tries to get used to the unusual load of fiber. Products like Beano have helped many people enjoy a fiber-rich diet. If it’s difficult for you to get enough fiber daily, consider using a product such as Unifiber, which can be added to foods or liquids, and even tube feedings.

What about fluids?

Fluids are just as influential as fiber. Without fluid, fiber particles remain dry and harden, actually making constipation worse. Four to eight glasses of water per day, plus juices, milk, and other beverages are necessary.

What if fiber and fluids aren’t sufficient to manage constipation?

• Diet should be your first treatment for constipation. However, sometimes peristalsis (muscle action in the large intestine) is slowed enough in Parkinson’s disease that other therapies may be indicated. If you get plenty of fiber and fluids, yet still have fewer than three bowel movements per week, it may be necessary to take further steps.

• A remedy used in some hospitals is called the Prune Juice Cocktail. Mix together:

1/2 cup applesauce

2 tablespoons wheat bran (“miller’s bran”)

4-6 oz prune juice

Store in refrigerator.Take a tablespoonful per day at first, gradually increasing until you find the amount that works best. Most people find this mixture quite palatable.

• Some patients report that a serving of prunes or prune juice including pulp 2-3 times per week is beneficial.

• It may be helpful to combine these two suggestions – have a daily spoonful or two of Prune Juice Cocktail, and 2-4 times per week, have a serving of cooked prunes.

• Ask your doctor about a fiber supplement, such as Metamucil, Citrucel, or Unifiber. Metamucil and Citrucel can be stirred into liquids, and are found in most drug stores and grocery stores. Unifiber can be mixed with liquids or stirred into thicker foods, like mayonnaise, applesauce, cooked cereals, and other foods; and if needed, can also be used in tube feedings. Your pharmacist can order Unifiber if not in stock or phone Niche Pharmaceuticals, Inc., Roanoke, Texas 76262, 1-800-677-0355.

• Manual “belly massage” from the bottom of the ribcage to the top of the pubic bone, performed 2-3 times daily, sends mechanical signals to the bowel to “keep things moving.”

• Train yourself to “honor the urge” to have a bowel movement. It may not always occur first thing in the morning or only at home! Likewise, be aware that the natural position for evacuating the bowel is squatting. Raised toilet seat devices may aid mobility, but are not ideal for bowel function.Try hiking your feet up on a small bench while sitting on the toilet.

• Ask your physician about using an over-the-counter stool softener such as Colace or Pericolace. If bowel motility is good but stool is dry and hard to pass, some health practitioners also advise occasional use of infant-sized glycerin suppositories to soften stool in the lower colon and reduce straining.

If you’ve tried all these solutions and still have a problem with constipation, you may need to consult your physician to see if prescription medications or referral to a specialist is indicated.

Lynda Murray MA, RD, LD, CSSD

Who would have thought there would be benefits to downing a cold one? The research continues on how beer, a 1,000-year-old beverage, might be beneficial to health.

We've known for some time about how wine might be "health insurance" against heart disease, but beer now also holds this claim to fame.

What's your preference? Ales, bitter, lagers, stout or wheat beers? Research shows that one drink a day for women or up to two drinks a day for men may reduce the chance of stroke, as well as heart disease – for starters. Then a whole keg of beer benefits follows, such as reduced risk of osteoporosis, high cholesterol, blood clots, atherosclerosis, heart attacks, diabetes, dementia, Parkinson's disease and gallstones. Yes, I am referring to beer, not omega 3 fatty acids.

An average beer is cholesterol free, fat free, contains 13 grams of carbohydrates, 25 milligrams of sodium, along with trace amounts of protein, calcium, potassium, phosphorus and vitamins B, B2 and B6.

It has been suggested that consuming one to two beers a day can reduce the risk of coronary heart disease by 30 percent to 40 percent over those who don't drink at all. Beer contains the same amount of antioxidants that red wine has and nearly five times as many antioxidants as white wine.

Alcohol is also praised for its ability to increase the amount of good cholesterol (HDL) in the blood. One glass of beer a day has been shown to significantly increase HDL cholesterol levels.

Beer also helps prevent the buildup of homocysteine, an amino acid linked with heart problems.

A recent report indicates that drinking wine or liquor can result in an increase in this negative homocysteine by 10 percent, while drinking beer did not.

Alcohol has also been shown to have a beneficial effect on inflammation, blood thinning and reducing the tendency for blood to clot. Think reduced heart attack and stroke.

Beer also may be associated with lower levels of insulin resistance. Eventually, beer may prove to be as protective for keeping diabetes at bay as a glass of wine. Other lifestyle factors typically associated with wine connoisseurs – such as healthier diet, exercise, limited nicotine, higher education level and income – are the positive benefits linked to this beverage of choice. It is believed that the alcohol is responsible for the protective effect noted, and wine can't alone claim the monopoly on heart and vascular benefits seen.

Weakened bones, fragile for fractures, are common among elderly people. Studies suggest that beer might benefit bones by the increase in blood estrogen levels. It is speculated that the flavenoid content of beer or minerals such as silicon are responsible. More research is continuing.

It has been estimated that more than 4.5 million Americans suffer from dementia or cognitive mental decline. This is expected to climb as life expectancy increases. The exact mechanism is not known at this time, but theories range from reduced narrowing of blood vessels in the brain, reduced risk of diabetes and psychological benefits.

A study of 51,000 people showed the risk of developing Parkinson's disease dropped by 30 percent for those who drank beer. Other protective lifestyle factors include maintaining ideal bodyweight and consuming black tea. Depression and exposure to heavy metals could increase risk. Head trauma increased Parkinson's disease risk 4 percent to 10 percent, providing additional fuel to the "wear your helmet" argument.

Beer in cooking is believed to have its roots in Western Europe. Alcohol is unique, because it has a much lower boiling temperature than water and evaporates quickly, leaving the characteristic taste of the beer behind.

Beer can be used as meat marinades. The alcohol both tenderizes and adds flavor. It can also be used in batters for fried foods, added to gravies to spice up the taste, or used in place of water or broth in soups and stocks. Try using beer as a cooking base for steaming sausages, shellfish or clams.

Malty beers add a sweet/nutty taste, while hop lagers can add a bitter/herbal flavor. Beer increases in bitterness as it simmers, so use a sweeter beer when cooking for long periods of time.

BEER BURGERS

1 large egg
2 garlic cloves, minced
1 (4-ounce) can diced chilies, drained
1/3 cup crushed saltine crackers
1/3 cup beer
1 tablespoon Worcestershire sauce
1/4 teaspoon dry mustard
1/4 teaspoon cayenne pepper
1 pound lean ground beef
6 slices cheese
6 hamburger buns

Preheat grill.
In a large mixing bowl, combine egg, garlic, chilies, saltines, beer, Worcestershire sauce, dry mustard, cayenne pepper and ground beef. Mix well.
Divide beef mixture into six patties. Grill 7 to 9 minutes on each side, turning once or until internal temperature reaches 165 degrees.
Top each burger with a slice of cheese.
Serve on buns.
Serves 6.

Remember these potential health effects are only for those who follow the moderation guidelines of one drink per day for women and two drinks per day for men. This doesn't mean you get to save your quota up and have seven or 14 beers on Friday night.

Drinking in excess of these guidelines has been associated with an increased risk of several serious health problems, such as cancer, high blood pressure and liver disease. Be warned that excess drinking can lead to liver damage, dangers of drunk driving and damage to fetuses of pregnant women, just to name a few.

Study: Vitamin D Insufficiency Often Accompanies Parkinson's Disease

By Miranda Hitti

WebMD Health News

Reviewed by Louise Chang, MD

Oct. 13, 2008 -- Parkinson's disease patients may be particularly likely to have low blood levels of vitamin D.

Researchers report that news in the Archives of Neurology.

They studied 100 Parkinson's disease patients, 100 Alzheimer's disease patients, and 100 healthy adults of the same age as the Parkinson's and Alzheimer's patients.

Participants provided blood samples, which showed vitamin D insufficiency in 55% of the Parkinson's disease patients, compared to 41% of the Alzheimer's patients and 36% of the healthy participants.

Vitamin D deficiency, in which people have even less vitamin D than people who have vitamin D insufficiency, was also more common among the Parkinson's patients (23%), compared to the Alzheimer's patients (16%) and the healthy participants (10%).

The findings held regardless of people's age, gender, and presence or absence of an Alzheimer's-related mutation in the APOE gene.

The study was a snapshot in time -- it doesn't prove that low levels of vitamin D cause Parkinson's disease or that taking vitamin D would help prevent Parkinson's.

But those possibilities should be studied, note the researchers, who included Emory University's Marian Evatt, MD, MS.

Dr. Andrew Weil, For the Calgary Herald

Q: I want to try your anti-inflammatory diet, but I'm not sure how many servings of each type of food are desirable.

Can you provide specific instructions?

A: Your question is very timely, because I recently designed a food pyramid for the anti-inflammatory diet to do just that. It is now available on my website.

As you know, the anti-inflammatory diet can help prevent the chronic inflammation that contributes to the development of heart disease, cancer, Alzheimer's and Parkinson's disease, and other age-related disorders. It is also a cornerstone of treatment for such autoimmune diseases as rheumatoid arthritis and lupus.

In addition to reducing inflammation, the diet provides steady energy and ample vitamins, minerals, essential fatty acids and dietary fibre. If you need to lose weight, it can help with that, too, but the diet wasn't designed as a short-term plan for weight loss. Rather, it is a way of selecting and preparing foods based on scientific research that can help you achieve and maintain optimum health over your lifetime.

When you look at the pyramid, you'll see that the diet steers you toward a wide variety of foods, ranging from lots of fresh vegetables and fruits (the foundation of all meals) to cooked Asian mushrooms, healthy herbs and spices and dark chocolate as a sweet treat. It minimizes consumption of the processed and fast foods that are some of the major contributors to chronic inflammation.

If you adopt this diet, each day you'll also be eating three to five half-cup servings of whole and cracked grains, one to two half-cup servings of beans and legumes, five to seven servings of healthy fats (one serving is equal to one teaspoon of extra virgin olive oil or organic, expeller-pressed canola oil; two walnuts; one tablespoon of freshly ground flaxseed; or one ounce of avocado). For daily protein and omega-3 fatty acids: two to six four-ounce servings of wild Alaskan salmon, herring, sardines and Alaskan black cod, a.k.a. sablefish.

You'll be going easy on other sources of protein, limiting servings to one to two per week of omega-3 enriched eggs, natural cheese (one ounce equals one serving), eight-ounce servings of dairy and three ounces of poultry or skinless meat.

The beverage category emphasizes tea -- two to four cups of white, green or oolong teas per day -- and if you drink alcohol, you can plan on a glass or two of organic red wine daily. In addition to dark chocolate, healthy treats include sorbet and unsweetened dried fruits. In the text accompanying the food pyramid, you'll find specific serving sizes for all the foods included.

I think you'll find the pyramid very easy to use. It may also introduce you to a variety of foods you haven't eaten before. Be adventurous. Try Anasazi beans, sea vegetables and bean-thread noodles, for example.

Dr. Andrew Weil is director of the program of Integrative Medicine of the College of Medicine, University of Arizona. He is an internationally recognized expert on medicinal plants, alternative medicine and the reform of medical education.

Kathrynne Holden, M.S., R.D.

All too often, people with PD lose weight, sometimes a critical amount of weight, unintentionally.There are many possible reasons for this.

• Depression can cause lack of appetite and desire to eat.

• Chewing or swallowing difficulties may make it hard to eat at a normal rate; it may take hours to finish a meal

• Some have difficulty manipulating a fork and knife

• Tremor and dyskinesia burn up many extra calories

• In other instances, people with PD report their appetites are good, they enjoy eating, and yet still mysteriously lose weight.

Often this weight loss is gradual, taking place over a period of several years. In other cases, weight loss can be sudden, occurring over a period of months or even weeks.

Weight loss --why is it a problem?

Unplanned weight loss should never be taken lightly. Studies report that the loss of just ten percent of a person’s maximum lifetime weight within the past ten years raises the risk for illness, bone fracture, and even death.

When we lose weight, precious muscle mass is depleted, too. Muscle wasting makes it difficult to walk, maintain proper balance, and perform the usual activities of daily living. Furthermore, the body becomes depleted of nutrients, ike vitamins and minerals. This depletion can lead to behavior change, altered mental function, depressed immune system, weakened bones, and other undesirable conditions.

Besides these concerns, we need regular meals to maintain our energy. People with PD often experience fatigue due to the disease or medications used to treat PD; lack of glucose can make this fatigue even worse. Food supplies a steady stream of blood glucose, which our body’s cells use for nourishment, energy, and work. Without this glucose, we may feel tired, listless, apathetic.

If you have lost weight without meaning to.....

If you or someone you know has lost weight within the past few weeks, you must notify your physician and ask for a referral to a registered dietitian.Why? Your medications, laboratory reports, food preferences, and any diagnoses must be taken into consideration when planning a weight gain program. A dietitian can help you solve these problems and design a safe, personal eating plan for regaining weight.

What if I don’t feel like eating?

Medications can cause a loss of appetite. Also, people with PD often lose the sense of smell, and this affects the ability to taste, and sometimes affects appetite as well.

When your appetite is poor, a big plate of food can seem discouraging. Don’t try to force yourself to eat large meals.You’ll need to eat a bit more than you have been, but not all at one time. Instead, plan for three small meals and three or more nutritious snacks each day. Meals should range from 300 to 600 calories each, and snacks from 50 to 300 calories, totaling enough calories to prevent weight loss. If weight loss has already occurred, calories should be adequate to allow you to regain weight.

Aim for a gradual weight gain of about one or two pounds per month. A number of my clients who have experienced gradual weight loss over as muchas ten years, have regained weight in this way.

What if I can’t finish meals on time?

Several conditions may make it hard to finish a meal. Sometimes bradykinesia (slowed movement) makes it difficult to handle utensils, or cut meat.

It may help to choose softer foods, like meatloaf, soups and stews, where the meat has been ground or cooked to tenderness, and doesn’t have to be cut. Avoid raw vegetables and lettuce salads – these are difficult to spear on a fork and convey to the mouth. Cooked vegetables, vegetable juices, and vegetable soups may be better choices. Pureed soups can be sipped from a mug, avoiding the need for a spoon. This can also help if chewing becomes difficult.

Sometimes it’s hard for me to swallow, or I feel like I might choke.

If it’s hard to swallow, or if choking occurs, your physician should order a visit to a speech pathologist. This is very important because there could be a danger of inhaling food. Food particles, liquids, or even saliva in the lungs can cause a form of pneumonia called “aspiration pneumonia.” Aspiration pneumoniais a very frequent cause of hospitalization among people with PD. The speech pathologist can perform a swallowing evaluation to determine whether you are at risk for aspiration pneumonia, and if so can show you safe swallowing techniques.You may be advised to eat soft, well-cooked foods or to avoid such foods as nut butters and raw vegetables until danger of choking is past.

When depression causes weight loss

Lack of appetite may be due to depression, a condition of sadness or hopelessness.This is often a temporary condition, but if it persists, your doctor may refer you to a counselor, or prescribe a medication to help. It’s especially important to eat at this time, because lack of nutrients can make depression much worse.

Follow the guidelines under “What if I don’t feel like eating?” Aim for small meals with frequent snacks. Meals and snacks should be as nutritious as possible, in order to provide all the vitamins and minerals needed to help overcome depression. A multivitamin-mineral pill is a good idea, too; ask your physician or pharmacist to recommend one.

Keep on hand the foods you like best. It’s easier to eat foods you like than those you don’t much care about.

Keep small snacks sitting out, where you can reach them easily. If you take levodopa, low-protein snacks are especially important. A dish of ice cream, a cup of hot chocolate (make with fortified soy or rice milk substitute if necessary),a few fig cookies, may be appealing. It’s better to eat sweets than not to eat at all!

Attractive, colorful meals are usually more appealing, so make the most of garnishes, textures, and flavors. A bright, cheerful setting, and soft music, may help, too.

Kathrynne Holden, M.S., R.D.

Why is nutrition of special importance for those with Parkinson’s disease (PD)?

Nutrition won’t cure PD, or slow its progression, so why is itimportant?

The answer is that PD impacts many aspects of health. It can slow the gastrointestinal tract, causing constipation, slowed stomach emptying, and swallowing problems; it can lead to loss of the sense of smell, and of taste. Medications used to treat PD can cause nausea and appetite loss. And, one of the most important medications, levodopa, must compete with protein for absorption from the small intestine.

People with PD are at increased risk for malnutrition; yet, with attention to diet, you will feel better, ward off nutrition-related diseases, and prevent hospitalization. A stay in the hospital can be costly, traumatic, and painful, but for those with PD, there are additional concerns.

• Some hospital staff members are unfamiliar with the special medications used with PD.

• Timing of medications can be difficult for staff, who may already have complicated schedules in place.

By following good nutrition practices, you’ll feel better, and are much more likely to stay healthy and avoid the hospital.

What is optimal nutrition for people with PD?

There is no single answer. PD affects each individual quite differently; some factors that can change your dietary needs include your age, your gender, whether you haveany other diagnosed conditions such as elevated blood pressure, food allergies, diabetes, etc. Also, medications used may have a wide range of side effects that can impact nutritional health. That includes medications for heart disease, blood pressure, and other conditions, as well as PD medications; it also includes many over-the-counter medications.

We will therefore discuss some of the most common concerns, some of which can become serious enough over time to require hospitalization. These include:

1. Bone thinning. Studies have shown that people with PD are at increased risk for bone thinning – both men and women alike. Other research has demonstrated that malnutrition, unplanned weight loss, and falls greatly increase the risk for bone fracture and other disabilities. As PD advances, it can increase the likelihood of falls. For those with PD, therefore, it’s especially important to eat meals that provide the bone-strengthening nutrients — particularly calcium, magnesium, and vitamins D and K. Also important is regular exposure to sunlight (which provides vitamin D, a bone-strengthening vitamin), and weight-bearing exercise, such as walking. Nutrients, sunlight, and weight-bearing exercise will help to keep the bones strong, preventing fractures and hospitalization.

2. Dehydration. PD medications can raise the risk for dehydration. Many people with PD don’t realize how important water is for health. Dehydration can lead to confusion, weakness, balance problems, respiratory failure, kidney failure, and death. In the United States, dehydration is responsible for about 1.8 million days of hospital care each year (about ten days per patient), and costs more than $1 billion annually.

3. Bowel impaction. PD can slow the movement of the colon, causing constipation. This makes it extra important to get enough fiber in the daily menu. If not dealt with properly, constipation can lead to a mass of dry, hard feces, impossible to pass normally. This is called bowel impaction. People with bowel impaction may require hospitalization, sometimes even surgery.

4. Unplanned weight loss. People with PD often lose weight without meaning to, due to nausea, loss of appetite, depression, and slowed movement. Unplanned weight loss together with malnutrition can lead to a weakened immune system, muscle wasting, loss of vital nutrients, and risk for other diseases. A loss of ten percent of the maximum lifetime adult weight is a predictor for illness and death. For example, if a man’s normal adult weight was 150 pounds, and he loses 15 pounds without meaning to -- even if over a period of several years -- he is at increased risk for illness and death.

5. Medication side effects. Medications perform important roles in helping to manage PD symptoms; however, in some people they can have unwanted side effects. Taking more than one medication increases the likelihood of these adverse effects, and it’s a good idea to watch carefully for any changes upon starting a new medications.

Furthermore, many people with PD use drugs for other conditions, such as high blood pressure, elevated cholesterol, etc. These medications may also have undesirable side effects or contribute to additive side effects. Some common side effects of PD medications include:

• nausea

• appetite loss, often followed by weight loss

• edema (fluid retention in the tissues)

• compulsive eating, and weight gain

6. Protein-levodopa interaction. One of the most important medications used to treat PD is levodopa (Sinemet, Sinemet CR, Madopar, Dopar, Larodopa, Prolopa, Syndopa). However, levodopa must compete for absorption from the small intestine with proteins in food, and it may be necessary to take care with the timing of meals and medication.

PD is a complicated disease, that affects each person differently. Still, there are many similar needs, such as the need for dietary fiber, fluids, and nutrients, that are common to most people with PD.

Your general nutrition needs

The Food Guide Pyramid can be adapted for use as a general guide to nutrition for those with PD. However, the pyramid does not distinguish among whole-grains vs. refined grains, or plant proteins and animal proteins, and these are important differences for those with PD. Studies have found that a high-fiber diet with plenty of plant foods can enhance the absorptionof levodopa, alleviate constipation, and provide the nutrients most needed in PD. So we must adapt the Food Guide Pyramid to obtain the best foodchoices to combat PD.

A daily menu based on whole grains, with plenty of vegetables and fruits, calcium-rich foods, and smaller portions of high-protein foods is the best possible choice for people with PD. The whole grains contain the fiber that helps control the constipation that often occurs in PD, as well as aiding in the management of blood sugar, blood pressure, cholesterol, and heart disease. Vegetables and fruits provide the antioxidants, phytochemicals, minerals, and vitamins that nourish and support the muscles, nervous system, and organs of the body. Calcium is particularly important, as it helps keep the bones strong, preventing fractures. And protein keeps the muscular system healthy; strong, toned muscles help to maintain balance and strength.

Isn’t it best to eat fresh vegetables and fruits?

Not necessarily. The processes of canning and freezing produce have advanced greatly, so that more nutrients are retained. Ideally, it’s best to eat some raw and some cooked or processed produce. However, if chewing or swallowing is difficult, or if it takes too long to eat raw vegetables and fruits, it’s fine to eat canned foods or cooked frozen foods.

How many servings should I have daily?

Each group in the Pyramid has a minimum and a maximum number of servings. The Breads and Grains group, for example, recommends six to eleven servings per day. A small or inactive woman needs about six servings, whereas a man or a larger or more active woman needs more servings.

What’s a serving size?

Servings are small and not difficult to incorporate into a daily eating plan. Here are some examples:

Serving sizes from the food guide pyramid:

Breads and grains group

6-11 servings daily

(Choose whole grain foods as often as possible, rather than refined flours and grains)

1 slice bread

1 6" corn or flour tortilla

1 oz ready-to-eat cereal

1/2 cup cooked cereal, rice or pasta

4 small crackers

2 large crackers

1/2 bagel or English muffin

Vegetable group

3-5 servings daily

(Choose several servings of red, yellow, orange, and dark green leafy vegetables each week; these are especially rich in antioxidants)

1/2 cup cooked vegetable

1/2 cup chopped raw vegetable

6 oz vegetable juice

1 cup raw leafy greens

Fruit group

2-4 servings daily

(choose several servings of citrus fruits, berries, and cherries each week; these are high in protective phytochemicals and antioxidants)

1 medium apple, banana, or orange

1/2 cup fresh berries or cherries

15 grapes

1/2 cup applesauce

1/4 cup dried fruit

3/4 cup fruit juice

Calcium (dairy) group

3 servings daily

4 oz canned sardines or salmon, including bones

2 cups cooked kale, chard, or collard greens

2 cups cooked navy beans

1 cup milk or yogurt, or fortified milk alternate (such as soy or rice “milks” fortified with calcium and vitamin D)

1 1/2 oz natural cheese

Protein (meat) group

2-3 servings daily

(Choose several servings of cooked dried beans each week, for their fiber, folate, and minerals)

1 cup cooked dry beans, split peas, or lentils

2 large eggs

4 TB peanut butter

2-3 oz cooked meat, fish or poultry

Fats, oils, & sweets

Use sparingly; choose non-hydrogenated vegetable oils and nut butters

Fats: Butter, margarine, sour cream, mayonnaise, salad dressing, oil

Sweets: sugar, jam, jelly, honey, syrup, soft drinks, desserts.

What about taking nutritional supplements, such as vitamins and minerals?

A multivitamin-mineral supplement is a good idea for most people, especially as we age. The aging metabolism is less well able to absorb and use vitamins and minerals, and supplements may help.

However, you should always discuss supplements with your registered dietitian. After age 50, iron supplements are not recommended unless you are anemic. Use of many medications, such as diuretics and blood thinners, in conjunction with supplements, can seriously impact your health. If you are at risk for hemorrhagic stroke, high-dose supplements of vitamin E may not be advisable. Also, some diseases, such as kidney disease, can be worsened by use of supplements. Discussion with a physician and a registered dietitian can help you choose the right supplements in the right amounts for your unique needs. Your pharmacist can help you select inexpensive, high-quality brands.

Vitamin B6 and Parkinson’s disease.

Before the combinations of levodopa/carbidopa and levodopa/benserazidewere produced, people with PD were prescribed levodopa alone. It was found that vitamin B6 prevented the absorption of the levodopa, so people were advised not to eat foods rich in B6, or to take B6 supplements.

Now, however, the medication commonly used combines carbidopa orbenserazide with the levodopa. These “protect” the levodopa, so that vitamin B6 in reasonable amounts is no longer thought to be a problem. It’s generally recommended that vitamin supplements for people using carbidopa-levodopa or benserazide-levodopa contain no more than about ten-fifteen milligrams of B6 daily; some people can tolerate more than that, others may be more sensitive. If you are sensitive to B6, or if you need to take very large amounts (over 15 mg), take the B6 at least two hours apart from the levodopa. You should inform your physician if you intend to use such large supplements of B6. Food sources of B6 include chicken, fish, pork, eggs, brown rice, soybeans, oats, whole wheat, peanuts, and walnuts, also fortified products such as cereals.

Bloating, obsessive eating, weight gain.

Some people find that after beginning PD medications, they experience abdominal bloating. They may also find that they have an urge to eat excessive amounts of food, which contributes to both abdominal bloating and weight gain. They may also have edema (fluid retention), often in the feet or lower legs, sometimes in the upper body.

A compulsion to eat should be reported to your doctor. Some people find that counseling is therapeutic and helps them to control the urge to over eat. Edema should also be reported, because it can cause both weight gain and elevated blood pressure.

If you experience edema, it will be important to control salt and sodium intake, because this can aggravate fluid retention in the tissues. Also, increase use of vegetables and fruits, which contain potassium and other minerals that help to flush fluids out of the tissures. It may be helpful to elevate the legs several times a day: sit back with your feet and legs resting on a chair or stool that is the height of the chair you are sitting in. This can help to drain fluids from the feet and legs

Kathrynne Holden, M.S., R.D.

A combination of levodopa with carbidopa or benserazide, known as the brand name Sinemet, Madopar, and other names, is an important medication used in treating Parkinson’s disease. However, there are some barriers to absorption of regular (quick-release) Sinemet/Madopar by the body.

1) If you take your Sinemet with a meal, or just after a meal, it may take avery long time for the Sinemet to be absorbed.This is because the stomach takes about one to three hours to empty food. If Sinemet is mixed with food, it takes the same amount of time to clear the stomach as the food does.

2) A high-fat meal takes even longer to clear the stomach. Fat is digested very slowly compared to carbohydrate and protein. If Sinemet is taken with a high-fat meal, it is further delayed in clearing the stomach.

3) Protein in the meal is broken down in the intestine into amino acids.These aminos must travel across the intestinal wall to get into the blood.Then they must cross the blood-brain barrier to enter the brain. Sinemet also must transit the intestine and the blood-brain barrier using exactly the same carrier system as the amino acids.

Most meals contain a large amount of protein, and the amino acids use up all the “carriers.” The Sinemet must wait until the carriers are free again, in order to cross over into the bloodstream. The same thing happens when Sinemet tries to get to the brain, where it does its work. Once more, amino acids clog all the “carriers” and Sinemet can’t get through to the brain. Therefore, it’s best to take Sinemet 30 to 60 minutes before eating a meal. This allows the Sinemet to be quickly absorbed before the food can interfere.

PROBLEM: Many people experience nausea when they first begin to use Sinemet. This usually disappears after a few weeks, although some people continue to feel nausea as long as they use Sinemet.

SOLUTION: Take the Sinemet along with some foods that don’t contain protein. Ginger tea is a good choice for many people, because it often “settles the stomach.” A graham cracker or soda cracker along with the ginger tea may help, too — these are very low in protein, and should not interfere with the absorption of Sinemet. You can find ginger tea in health food stores. Ginger ale may also be helpful for some people. If your nausea is not relieved after a few weeks, discuss this with your doctor, who may wish to prescribe an anti-nausea medication. What about Sinemet CR/Madopar HBS?

Sinemet CR (“Controlled Release”) and Madopar HBS and their generic forms, are designed to be released slowly into the blood over a long periodof time, providing a continuous, smooth, supply of levodopa. It was also designed so that it can be taken with a meal. However, it requires more time to become effective than regular Sinemet, and taking it with food means it will be even longer before it takes effect. If you spend a great deal of time in an “off state” (time when medications are not working) then it may be best to take Sinemet CR 30-60 minutes before eating a meal, just as you do regular Sinemet.

On-off fluctuations. In the early stages of PD, the brain continues to produce dopamine, although in reduced amounts. Medications such as the levodopa in Sinemet boost this amount, so a steady supply of dopamine reaches the brain at all times. Later on, the brain ceases to produce dopamine in any significant amount, and must rely totally on Sinemet. This is when “on-off fluctuations” start to occur.

When levodopa begins to take effect and there is a good dopamine response, the person is said to be “on,” functioning and moving well. As the levodopa begins to lose its effect and movement becomes more difficult; the person is said to be “off” or experiencing a “wearing off” phenomenon. These on-off fluctuations are a common problem in patients who have taken Sinemet for several years.

New medications, such as the agonists ropinerole and pramipexole, and the COMT-inhibitor tolcapone, have greatly extended the effectiveness of levodopa, and decreased “off time.” Nevertheless, in advanced PD, fluctuations can still be a problem.

The nutritional concern at this point is the amino acids previously discussed. These must cross the cells of the intestinal walls to get into the blood, and then must cross the blood brain barrier to get into the brain. These amino acids use exactly the same pathway as levodopa to get into the bloodstream and the brain.

Therefore, a meal high in protein combined with Sinemet can seriously interfere with levodopa absorption, particularly at the level of the brain receptors. Research indicates that many people who experience "on-off" fluctuations can benefit by adjusting their protein intake.For those wishing to adjust their protein intake, there are three ways currently considered feasible.

1) Balanced protein plan. This is the plan I highly recommend. With the help of a registered dietitian, determine your protein needs; if you are otherwise healthy, this will be about 1/2 gram of protein per pound of body weight per day. Then, divide this amount equally among three meals, morning, midday, and dinner. For most people, this will result in less protein than the typical western diet provides; also, it will be evenly divided, providing for more consistent levodopa absorption. Be sure to take the levodopa at least 30 minutes before meals; if you need to eat snacks between meals, choose those with little or no protein – fruit, juices, etc.

2) Evening protein. I do not recommend you attempt this plan without the assistance of a registered dietitian. High-protein foods are eaten only in the evening, so that mobility is improved during the day. This plan is not ideal, however, because mobility is greatly reduced during the night time, and many people find they have difficulty turning in bed, or getting up at night. Some people then forego eating any protein in the evening, so as to have better control of PD symptoms throughout the night; such deprivation leads to protein starvation and illness, even hospitalization. If you are extremely protein-sensitive, ask for a referral to a registered dietitian, who can assess your protein needs and help you plan a safe and effective “evening protein menu.”

3) High-carbohydrate (high-carb) plan. Eat meals that consist of a ratioof five-to-seven parts carbohydrate to one part protein (5:1 to 7:1).

In the small intestine, carbohydrate breaks down into glucose, and enters the bloodstream. Protein breaks down into amino acids, which enter the blood stream with glucose. A high ratio of carbohydrate to protein causes a large amount of insulin to be released into the blood. Insulin removes some of the amino acids from the blood and may help lower the competition between aminos and Sinemet.

The high-carb meal plan appears to work well for about two-thirds of the people who try it. It allows small amounts of protein throughout the day, and a more natural menu. It has disadvantages, however:

- it is difficult to understand and plan meals and recipes in such a high ratio

- it is very difficult to devise a menu under 1800 calories per day, and this is too much food for some people

- it is difficult to eat meals away from home – restaurants, friends’ homes, and traveling all pose problems for those wishing to maintain a high-carb diet plan.

- furthermore, a high-carb diet could make some conditions, like diabetes, lung disease, and high serum triglycerides, much worse.

A high-carb menu plan should only be undertaken with the help of a registered dietitian. An RD can determine your individual protein needs, and provide accurate information on the amounts of protein and carbohydrate in foods. It should also be discussed with one's physician first. Some people find it so successful that they may need less levodopa, and your physician needs to work closely with you to determine the correct amount. Otherwise, you might find yourself over medicated.

Other protein-related information. Meat, poultry, fish, milk, cheese, and eggs are all very high in protein. For many people, milk in particular block slevodopa, to a greater extent than other protein-rich foods. To get better results from your Sinemet, use high-protein foods moderately, along with large helpings of fruits, vegetables, and grains.This means that at a meal you should eat a small portion (3-4 ounces) of meat, poultry, fish, cheese, or eggs, accompanied by fruit, vegetables, and bread, cereal, pasta, or other grains.

If milk is a problem for you, a good substitute is a “milk alternative” such as soy or rice milk. Be sure to choose the kinds that are fortified with calcium and vitamin D. Westsoy soy beverage has a fortified version. Rice Dream also carries a fortified version. You can get these products at larger grocery stores or at health food stores.

Carnation Instant Breakfast is inexpensive, and an Instant Breakfast Shakeworks well for most people, as long as it’s made using soy or rice milk, and some fruit. However, it contains a small amount of dried milk, and those who are very sensitive to milk protein may not be able to use Instant Breakfast.

Plant protein is a good choice for part of your protein needs. Plant protein (dried beans, nuts, and seeds) contains a high ratio of carbohydrates to protein, whereas meat, fish, and poultry contain no carbohydrate. It’s a good idea to eat several servings of cooked dried beans, peas, or lentils each week. Legumes have more fiber than any other food. Fiber helps with constipation and is heart-protective as well. Good choices are bean soup, refried beans, three-bean salad, and patties made from soy protein, like Morningstar Farms “Better’n Burgers” or Boca Burgers.You can find these and others in the freezer case at the grocery stores.

Tuesday, November 4, 2008
By GARY BROWN

November is National Alzheimer's Disease Awareness Month, casting a spotlight on a disease that is stealing an increasing number of lives.

"As many as 5 million Americans are living with Alzheimer's disease," notes the Web site for the Alzheimer's Association.

"Alzheimer's destroys brain cells, causing problems with memory, thinking and behavior severe enough to affect work, lifelong hobbies or social life. Alzheimer's gets worse over time, and it is fatal. Today it is the sixth-leading cause of death in the United States."

We don't have to sit and wait for the disease to strike us or our loved ones. Researchers have developed guidelines for healthy living that reduce the risk of developing neurodegenerative diseases such as Alzheimer's and Parkinson's.

The following guidelines were taken from a report — "Environmental Threats to Healthy Aging from Greater Boston Physicians for Social Responsibility and the Science and Environmental Health Network" — that indicated neurodegenerative diseases are not necessarily inevitable.

The report presents science and analysis indicating environmental factors — diet, stress, exercise and exposure to chemicals — "are key drivers in Alzheimer's and Parkinson's diseases."

The report said people can take the following actions to reduce the risks of developing Alzheimer's and Parkinson's:

1. Practice good nutrition from the beginning of life

"Prioritize healthy and nutritious food for children, teenagers, and adults. Consumption of fast food and calorie-dense snacks ... should be reduced or eliminated."

2. Eat lots of fresh fruits and vegetables, especially deep-green and orange vegetables

"Fruits and vegetables provide essential antioxidants, vitamins, and other critical micronutrients."

3. Eat foods high in omega-3s

"Eat fish at least once a week. ... If using fish oil, chose a brand that has been distilled to remove toxicants. Minimize consumption of fish that are high in contaminants such as mercury and PCBs."

4. Avoid routine consumption of sugar

"Table sugar, high fructose corn syrup, maple syrup and honey, and beverages and foods containing them, cause rapid elevations of blood sugar."

5. Consume low-glycemic carbohydrates, such as whole grains and legumes (such as chick peas and lentils)

"Other examples include brown rice, pearled barley, steel-cut oats, rye, buckwheat, fruits, non-starchy vegetables, pasta, winter squashes, and tubers (yams, sweet potatoes)."

6. Modest consumption of alcohol is okay

"Beverages like red wine and green tea contain important antioxidants ... and caffeine may reduce the risk of Parkinson's disease."

7. Avoid food additives, such as aluminum

"Recent evidence suggests that dietary aluminum may increase the risk of Alzheimer's disease. Highest aluminum levels in food have been reported in some pancake and waffle products — including mixes, frozen and restaurant varieties."

8. Reduce exposure to toxicants

"Avoid hazardous exposures to toxicants such as lead and solvents during building and remodeling projects. ... Also eliminate or reduce pesticide use in the home and on lawns and gardens."

9. Increase physical activity

"Walking more each day can improve health, prevent overweight and obesity, and help maintain independence."

10. Increase social activity

"Regular social engagement with others reduces the risk of cognitive decline in later years. Volunteer, get involved in com-munity activities, and stay in touch with family members."

11. Reduce stress

"Many of us are constantly expected to multitask and respond instantly to ever more rapid communications. Try to find even a few minutes a day to relax."

12. Exercise your brain

"Exercising your brain may be beneficial for maintaining healthy cognition. Common sense ways to do this include crossword puzzles and word games, chess, and activities that require critical thinking."?