Clinical Nutrition

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Professional Advisors

 

Professor Leon Epstein

Previous  Chairman

Department of Social Medicine

Hadassah Medical Organization

Kiryat Hadassah

Jerusalem, Israel

Professor Tzvi Dwolatzky

Director of Geriatrics

Rambam Health Care Campus

Haifa, Israel

President, Israel Geriatrics Society

Aviva Epstein, RD.

Previous Head Dietitian

Rambam Health Care Campus

Haifa, Israel

Kathy King, RDN, LD, CEO

Helm Publishing, Inc.

 

Clinical Nutrition 

high blood pressure

cholesterol

diabetes

diabetes in pregnancy

osteoporosis

pre/post surgical

enteral tube feedings

geriatrics

pediatrics

maternal

bulimia

anorexia

Parkinson’s

orthopedics

gout

food allergies

 

  NUTRITION      AND THE          ELDERLY

        YAAKOV  LEVINSON, M.S., Nutritionist

The elderly are at high risk for poor nutritional status (1).  Malnourished and nutritionally deficient elderly people are seen daily in clinics and hospitals.  Malnutrition and undernutrition probably are responsible or at least significantly contribute to many of the non-specific symptoms observed in elderly persons such as mental confusion, chronic fatigue, a general feeling of ill-health, and loss of appetite (2).  All of these symptoms may eventually lead to even more pronounced malnutrition.

It has been reported that protein-calorie malnutrition is common in the institutionalized elderly (3).  One can only imagine how much malnutrition actually exists among the general geriatric population undetected by scientific studies!   Protein-calorie malnutrition is the most severe and important nutritional problem of the elderly (4,5). Many other nutritional deficiencies may occur simultaneously or independently as will soon be discussed.  The most frequent complication of nutritional deficiency in these persons is acute infection which may lower the older person’s quality of life or may even become life threatening (6).

Malnutrition in the elderly is brought about by changes in economic circumstances and way of life which often occur in the elderly and retired, and by the increasing incidence of illness and disability leading to an alteration in dietary intake, absorption, and metabolism of nutrients.

The high-risk status of the elderly for low intakes of nutrients is due to many factors which will be listed and discussed at length.

FACTORS LEADING TO DIETARY DEFICIENCY IN THE ELDERLY

1. Physical and mental disabilities (limited mobility)

2. Psychosocial changes (social isolation and apathy)

3. Fixed income (poverty)

4. Medical conditions

5. Decline of body functions

6. Medications (alcoholism)

7. Oral status

8. Susceptibility to fads

9. Ignorance

10. Iatrogenic causes

 

  NUTRITION               AND                       PARKINSON’S

 

             YAAKOV LEVINSON, M.S., NUTRITIONIST

GENERAL CONSIDERATIONS

There is no special diet for people with Parkinson’s.  Recommended to eat a general healthy diet.

Physical activity may help prevention of Parkinson’s and to the slowing of its progression.

The medications used with Parkinson’s may cause nutrition-related side effects, such as nausea, poor appetite and constipation.  These effects are usually when the medications are first introduced. Crackers and ginger may help reduce nausea. Hydration (6-8 glasses per day) and fiber are recommended  for constipation.

Persons with Parkinson’s are prone to weight loss.  Nutritional consultation is recommended. Oral formula supplements are indicated if one is unable to maintain his weight on oral diet alone.  Liquid thickeners or pudding supplements are used with swallowing difficulties.

NUTRITION AND LEVODOPA

The drug levodopa is synthesized in the brain into dopamine.  Levodopa is today the most important drug for the management of Parkinson’s.

Levodopa is usually given with Carbidopa, which prevents the nausea that may be caused by Levodopa when given alone.

Common side effects of Levodopa include: nausea, vomiting and loss of appetite.

EFFECTS OF PROTEIN FOODS ON LEVODOPA

Branched-chain amino acids directly interfere with levodopa absorption.  Leucine, isoleucine and valine are branched-chain amino acids found in red meat, dairy, chicken, fish, poultry and eggs, as well as protein powders and whey supplements.  

Manipulation of dietary protein may reduce absorption fluctuations of levodopa in some persons. Ask if one feels that eating protein foods decreases the effectiveness of his levodopa medication.  If so, suggest a 40 minute delay between taking levodopa and eating a meal. Arrange that the main protein-containing meal is eaten in the evening.

Iron supplements can decrease absorption of levodopa, so they should not be given within 2 hours of levodopa.  Multivitamins with minerals should not be taken at the same time as levodopa.

 

 

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