It is important for everyone to have a well balanced, healthy diet, but for those with Tremor this is particularly important. This information should help you to understand how to maintain a healthy and balanced diet and also how to cope with some of the eating challenges that Tremor may present.
You may find that Tremor affects your weight considerably but you should try to maintain a healthy weight as being over or underweight can affect your health in many ways.
Tremor may cause you to gain weight as you become less mobile and extra weight can strain the joints and make movement even more difficult. If this happens you may be advised to watch your diet and control the calories you consume, for example by avoiding fried foods, sweet desserts, cakes and biscuits and sugary drinks.
More commonly though people with Tremor find that they lose weight and have to try hard to maintain a high intake of calories so as to avoid excessive weight loss. Weight loss may be due to a loss of appetite or because eating or swallowing becomes more difficult, or it may be that your body simply doesn’t absorb nutrients efficiently, or you may be using extra energy in coping with your Tremor symptoms. It also seems that various medications may also have different influences on body weight. Whatever the cause you will need to consume more calories in whichever way suits you:
Food supplements (not to be confused with vitamin and mineral supplements) are available either from pharmacies or on prescription and may be helpful for those who are unable to eat enough and become considerably underweight, perhaps because of nausea, loss of appetite or difficulty in eating. If you do lose a lot of weight and find it hard to consume the additional calories your body requires it may be helpful to discuss the possibility of food supplements with your doctor or dietician.
If you think that your weight is fluctuating, it is a good idea to weigh yourself regularly and keep a record of your weight over a period of time as this can be useful information for your doctor or a dietician if needed.
Constipation is a common problem for those with Tremor and altering your diet may be a key factor in overcoming or reducing this symptom. Increasing your intake of fibre rich foods such as fruit and vegetables, pulses and lentils, wholewheat bread and cereals, can help but beware that too much fibre can cause constipation, so you do need to get the balance right. Increasing fluid intake can also help as fluid is absorbed by the bowel to soften stools and make them easier to pass, and exercise is beneficial as this helps to stimulate the bowels. Remember that a bowel movement is not necessary every day – emptying the bowel only three to four times as week is fine so don’t worry if you do not have a bowel movement every day.
If constipation is not relieved by altering your diet and increasing your exercise then it is best to speak with your doctor.
A balanced diet will contain a wide variety of foods from the various food groups below. Ideally you should choose an item from each food group for each meal throughout the day as you will then obtain all the nutrients required by the body to keep it healthy, although for some this may not be possible.
Current general dietary recommendations include:
These starchy and/or sugary foods provide the basic fuel or energy your body needs as they break down once digested and produce glucose. Typical carbohydrates are bread, potatoes, pasta, rice, cereals, biscuits and cakes
These are the basic building blocks for your body and are needed for growth and repairing the body. Typical proteins are meat, dairy products, nuts, pulses, eggs and fish
Fruit and vegetables
These are a good source of fibre and are essential for healthy bowels and avoiding constipation. They also contain some carbohydrate and many vitamins and minerals
Fats and sugars
Although fats and sugars can be harmful if consumed in large quantities, they are essential for producing energy and ‘essential fatty acids’ are also needed for the efficient absorption of some key vitamins.
It is very important to drink plenty of fluids, preferably eight to 10 cups daily - water, juices, tea, coffee, milk etc. Alcohol may be included in moderation and can be beneficial if it helps you to keep up your social life - your doctor will advise you if you need to avoid alcohol. If you have problems with your bladder or bedwetting it may be advisable to drink mainly in the morning and early part of the day. You may also find that carbonated or fizzy drinks make you feel bloated so may be best avoided. If dry mouth is a problem then frequent sips of water or using an oral rinse or spray can help. Sucking a sweet or chewing gum can also stimulate the production of saliva and so help alleviate dry mouth.
Vitamins and minerals
There are a variety of vitamins and minerals contained in food and by eating a variety of foods from the various groups above you should be getting all the vitamins and minerals your body needs. If you are deficient in any particular vitamin or mineral it is generally better to increase your intake of foods containing the particular nutrient rather than a supplement but for some a supplement may be the only answer, particularly if your body does not absorb nutrients well. It is best to speak to your doctor or ask to be referred to a dietician if you have any concerns.
Osteoporosis, or brittle bones, is particularly important to avoid as those with Tremor are more likely to fall, so a good intake of calcium and vitamin D should be maintained to help prevent breaks or fractures in bones.
Vitamins A, D, E and K tend to be found in milk and dairy food and are fat-soluble, which means that they remain in the body for some weeks before being used or expelled.
Vitamins B (complex) and C are mostly found in citrus fruit and green, leafy vegetables and need to be consumed daily as they are water-soluble and therefore do not remain in the body for any period of time.
Minerals are present in many foods although often only in very small, or trace, quantities. Key minerals include calcium, chloride, chromium, fluoride, iodine, iron, magnesium, manganese, phosphorous, potassium, selenium, sodium, sulphur and zinc.
Certain vitamins and minerals are known as antioxidants as they can help reduce the damage caused by oxidation, a normal process occurring in all cells in the body. Oxidation produces a substance which is known to cause cell damage and can lead to disease such as Parkinson’s, Alzheimer’s, cancer and heart disease for example. It is therefore good for general health to ensure that you eat foods containing antioxidant vitamins and minerals although there is no evidence at present to suggest that these will help with Tremor. Providing you are eating a balanced and healthy diet you are unlikely to need to take antioxidant supplements but if you have any concerns do ask your doctor or dietician.
Co-enzyme Q10 has strong antioxidant properties but it is not at present recommended as a treatment for Tremor.
Most medications can be taken at any time and do not need to be specially timed in relation to mealtimes.
It is best to avoid taking antacid/indigestion tablets at the same time as Tremor medications as they can interfere with medicine absorption. They can however generally be safely taken at a different time to your medications.
Depending on the country you live in your doctor may be able to refer you to any of the following specialists to give advice on diet or eating problems you may experience.
A dietician can provide advice on all aspects of nutrition and diet. They will advise on maintaining a healthy diet and adjusting it to suit your needs and symptoms, bearing in mind your specific needs in relation to your medications.
A speech and language therapist will be able to help you with problems in swallowing and ways to overcome such difficulties, as well as speech difficulties. They can also help eliminate any other possible causes of swallowing problems before any dietary changes are made.
An occupational therapist will be able to look at ways to make food preparation easier, possibly by altering the set up in your kitchen or home. Simple changes to your kitchen and dining area can make all the difference, for example:
An occupational therapist will also be able to advise on special equipment available to make food preparation and mealtimes easier and more comfortable.
There are various practical ways in which you can help yourself follow a healthy diet - all too often the effort involved in preparing food can mean you don’t have the energy or inclination to eat properly so the following tips may be helpful in avoiding or minimising this problem.
Shopping and preparing meals
Careful planning can make shopping and preparing meals far easier and an occupational therapist will be able to give you tips to help with this aspect of your routine. Here are some tips to help you:
Special food aids
Special aids for eating are available. Ask your occupational therapist for information on what is available in your country and suitable for you. Below are some suggestions that may help although not all may be available where you live:
Eating and swallowing
Being comfortable when eating is important in ensuring that you are able to eat and swallow food.
If a meal takes a long time and becomes cold and unappetising you may prefer to eat smaller portions and four or five smaller meals rather than 3 large meals each day. It is also a good idea to time meals so that medication is working properly – eating is very difficult during ‘off’ periods so try to avoid meals when ‘off’.
If you experience a lot of difficult swallowing or opening your mouth ask to see a speech and language therapist. They will be able give tips on the consistency and texture of food to make it easier to eat, and also on ways of eating. Some tips for easier swallowing are:
A semi-solid diet will make swallowing much easier and in extreme difficulty a puree diet may be recommended but you should only follow such a diet on the advice of your doctor, dietician or speech and language therapist.
Below is a sample of a daily eating plan with regular meals which include a wide and balanced range of foods from the various food groups.
These suggestions are for guidance only and there are of course other options and alternatives available.
Fruit or fruit juice; cereal (wholewheat if constipation is a problem) with milk; bread or toast with butter or margarine and jam or other spread; bacon, sausage, egg, cheese, cold meats etc
Meat, fish, eggs, cheese, pulses, lentils or other protein; potato, rice, pasta, noodles, bread or other carbohydrate; vegetables or salad; yoghurt, milk pudding or fruit drink
As midday meal
Snacks between meals
Fruit, cakes, biscuits, sandwiches, cereals.
You should drink with meals and between them too, for example tea, coffee, fruit juice, water, milk, soup. Beware of drinking too many carbonated drinks as they may make you feel bloated and unable to eat your snack or meal.
We would like to acknowledge the use of information taken from the European Parkinson’s Disease Association website www.rewritetomorrow.eu.com/